Impact of prophylactic beta-blocker therapy to prevent stroke after noncardiac surgery

The American Journal of Cardiology
Felix van LierDon Poldermans

Abstract

beta Blockers are widely used to improve the postoperative cardiac outcome in patients with coronary artery disease scheduled for noncardiac surgery. However, recently serious concerns regarding the safety of perioperative beta blockers have emerged. To assess the incidence, risk factors, and beta-blocker use associated with postoperative stroke in the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) trials, we evaluated all 3,884 patients of the DECREASE trials for postoperative stroke. All cardiac risk factors and medication use were assessed. The incidence of stroke within 30 days after surgery was recorded. The incidence of postoperative stroke in the DECREASE trials was 0.46% (18 of 3,884). For the beta-blocker users, the incidence was 0.5%. All the strokes had an ischemic origin. A history of stroke was associated with a greater incidence of postoperative stroke (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.2 to 11.6). Statins and anticoagulants were not associated with postoperative stroke (OR 0.85, 95% CI 0.3 to 2.4; and OR 1.27, 95% CI 0.4 to 4.6, respectively). No association with bisoprolol therapy was found (OR 1.16, 95% CI 0.4 to 3.4). In conclusion, with a low-dos...Continue Reading

References

Jul 29, 2005·The New England Journal of Medicine·Peter K LindenauerEvan M Benjamin
Oct 8, 2005·BMJ : British Medical Journal·Donald RedelmeierAlexander Kopp
Sep 5, 2006·Journal of the American College of Cardiology·Don PoldermansUNKNOWN Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo Study Group

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Citations

Jun 17, 2011·Current Opinion in Critical Care·Erik J BakkerDon Poldermans
Dec 3, 2014·Annales Françaises D'anesthèsie Et De Rèanimation·B RozecY Blanloeil
Jan 21, 2011·Expert Opinion on Drug Safety·Niels J C RavensbergenDon Poldermans
Feb 20, 2013·Nature Reviews. Urology·Thomas G WeiserRonald V Maier
May 25, 2012·Acta Anaesthesiologica Scandinavica·S J WylieM G Irwin
May 1, 2020·Biomedicines·Sarah Lemke, Andreas Vilcinskas
Apr 25, 2013·Anesthesiology·George A MashourSachin Kheterpal
May 3, 2013·Journal of Cardiovascular Pharmacology and Therapeutics·William H Frishman
Apr 17, 2015·The Cochrane Database of Systematic Reviews·Katayoun MostafaieDarrell Harrington

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