Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery
- Type de publi. : Article dans une revue
- Date de publi. : 30/08/2024
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Auteurs :
Matthieu LegrandJérémy FalconeBernard CholleyHélène CharbonneauAmélie DelaporteAdrien LemoineMatthias GarotAlexandre JoostenClaude MeistelmanDelphine Cheron-LeroyJean-Philippe RivesBruno PasteneAntoine DewitteStéphanie SigautMarc Danguy Des DesertsCyrille TrucMatthieu BoissonSigismond LasockiPhilippe CuvillonUgo SchiffSamir JaberMorgan Le GuenAnaïs CaillardStéphane BarEdmundo Pereira de Souza NetoVincent ColasFlorin DimacheThibaut GirardotElsa JozefowiczSimon ViquesnelFrancis BerthierEric VicautEtienne GayatSimon MonziolsMylene DefayeThibault CamusJean-Jacques RobinAlexandre OuattaraIoana FetitaOlivier Joannes-BoyauEline BonnardelRémi BouquerelAntoine StrzeleckiThibaut FayonChristophe PelletierBenjamin Le GaillardThibaut GirardotGéraud AmoussouMaalik El BouyousfiBruno GanasciaCalliope ButrulleSoizic GergaudPierre HabrialSolène PessiotEmmanuel SamsonCaroline WolffNevena StankovaFarida AouatiJuliette KavafyanVlad SuparschiDan LongroisJulie Le RoyBenoit RossignolOlivier HuetChristophe BoissonPierre Olivier BonninMohamed DhaouadiGhislaine GardesMikael PerinSophie BrunetYann GricourtMarc-Olivier FischerStéphane DebrocziLucie RetournayPierre StrubPatrice VivinRachel DupaysT KerforneGabriel VianetVirginie ManzanoEric NollPierre-Olivier LudesThiên-Nga Chamaraux-TranCédric CireneiDjihad HamrounBenoit LebasGrégoire Andrieu AndrieuVincent EtienneRaphaël CinottiNatacha SimonDenis FrascaHélène BeloeilAmandine Le GallPetyo TechevLudovic MeuretJérémie JoffreHervé DupontBeny CharbitArthur DavyDavid LoboJean-Michel DevysBenjamin SoriaClémentine CholetCyrus MotamedAnne WynieckiValérie BillardMigena DemiriClement MilletSamuel DegoulChristophe CanevetCéline MounierFlavie DesrumauxJulia MartinezClaire TexierBenoit VoisinGuillaume DubreuilJacques de MontblancClaire MengelleLaura RuscioEmmanuel FutierJulie FayonBenoit BaiettoMarie VignaudYoann MunierBertille PaquetteDiana SaptefratZakia MachroubJean-Sébastien AubertGeorges Abi AbdallahNicolas PolgeNajla DachraouiAnne GodierDiane ZlotnikHélène NougueDarless ClausseSabrina MaSherifatou Salami-AdjavonPatrick RossignolFrancis BerthierRomain BarthélémyGabriel VianetDamien LogeartPeggy ReinerKarine PautratAlex HongMarine CoroirClaire MayeurJacques ThesFlorent LaverdureSofiane SeriVioleta BercanCristian Radu IonescuCaroline Gonnet PintonMarc LeoneNathalie LesavreJeanne ChatelonMarion PoirierAdrien RivoryStéphanie RoulletSean CoeckelenberghLeila ToubalJoanna RamadanKarine Nouette-GaulainBruno RalecChloé ThillChristophe GiacardiEtienne MontelescautPhilippe AriesBenoît TavernierJulie BelletRomain DelassusHélène TribouillardDaniel VerzilliAlice MillotAudrey de JongMarie GeniezVirginie MarreMichaëla PenneYvan PouzeratteGuillaume RaoMaxime CoutrotAlice BletBenoit PlaudEmmanuel BastoMathilde PonsinMarie-Christine BecqMaïté ChaussardAristide NtaheFrançois DépretLucie GuillemetArnaud ValentLyse FloresJulien BureySarah FerayYoann ElmalehSophie DupeyratThomas BauryClémentine TaconetThomas RimmeleElodie MazockyMarie Luce ParrouffeCatherine JadaudStanislas AbrardPierre-Antoine TroncheArthur VialEmma AkaAnne-Sophie BellocqJean-François CarabalonaBlandine FayardJean Marie GuyaderLetitia HuriauxIngrid MillotAntoine LamblinMarine DutourMathilde Roukhomovsky-MorettiPascal MeuretNadir OmraniBarnabé RaymondClemence RoyFlorent SigwaltXavier MerindolMathieu DesmardLouis BourreauPierre-Antoine AllainCharlotte Dei SvaldiBrenton Alexander
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Organismes :
University of California [San Francisco]
University of California
Hôpital Claude Huriez [Lille]
Hôpital Européen Georges Pompidou [APHP]
Clinique Pasteur [Toulouse]
Hôpital Marie-Lannelongue
CHU Tenon [AP-HP]
Sorbonne Université
Hôpital Claude Huriez [Lille]
Hôpital Bicêtre [AP-HP, Le Kremlin-Bicêtre]
Centre Hospitalier Régional Universitaire de Nancy
Hopital Saint-Louis [AP-HP]
Département d'anesthésie [Gustave Roussy]
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
Immunology from Concept and Experiments to Translation = Immunologie Conceptuelle, Expérimentale et Translationnelle
Hôpital Beaujon [AP-HP]
Groupe d'Etude de la Thrombose de Bretagne Occidentale
Hôpital d'Instruction des Armées Clermont Tonnerre
Hôpital Edouard Herriot [CHU - HCL]
Pharmacologie des anti-infectieux et antibiorésistance [U 1070]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
Centre Hospitalier Universitaire d'Angers
Centre Hospitalier Universitaire de Nîmes
Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts
Faculté de Médecine - Clermont-Auvergne
Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
Centre Hospitalier Régional Universitaire [Montpellier]
Hôpital Foch [Suresnes]
Hôpital de la Cavale Blanche - CHRU Brest
Optimisation des régulations physiologiques
CHU Amiens-Picardie
Simplification des soins chez les patients complexes - UR UPJV 7518
Centre hospitalier de Montauban
Hôpital Saint Philibert [Lomme]
Centre Hospitalier Universitaire [Strasbourg]
Centre hospitalier de Valence
Hôpital Roger Salengro [Lille]
Service d'anesthésie réanimation chirurgicale [Rennes]
Centre d'Investigation Clinique de Besançon
Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy]
Service d'Anesthésie-Réanimation [AP-HP Hôpitaux Saint-Louis Lariboisière]
Marqueurs cardiovasculaires en situation de stress
Hôpital d'Instruction des Armées Clermont Tonnerre
Hôpital d'Instruction des Armées Clermont Tonnerre
Hôpital d'Instruction des Armées Clermont Tonnerre
Hopital d'instruction des armées Sainte-Anne [Toulon]
Hôpital d'Instruction des Armées Clermont Tonnerre
Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
Centre Hospitalier Régional Universitaire [Montpellier]
- Publié dans JAMA Cardiology le 25/10/2020
Résumé : Importance: Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.
Objective: To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.
Design, Setting, and Participants: Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.
Intervention: Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).
Main Outcomes and Measures: The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.
Results: Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.
Conclusions and Relevance: Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.
Trial Registration: ClinicalTrials.gov Identifier: NCT03374449
Fichiers liés :
2024 Legrand et al., Continuation vs Discontinuation.pdf
Source