Preoperative care/Catalogs/Beta-blocker evidence table
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| Patients | Intervention | Comparison | Outcome | Results | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mortality | Stroke | Beta-blocker toxicity | ||||||||
| Rx | Control | Rx | Control | Rx | Control | |||||
|
Decrease IV[1] |
1066 patients * Vascular: <1% * RCRI>2: 0% |
Bisoprolol * Started a median of 34 days preop * Target HR: >50 bpm |
Open label | Mortality at 30 days | 1.9% | 3.0% | 0.8% | 0.6% | Heart failure, clinically significant bradycardia or hypotension | |
| 0.6% | 0.4% | |||||||||
| POISE[2] 2008 |
8351 patients * Vascular: 42% * RCRI>2: uncertain |
Metoprolol * Started day of surgery * Target HR: >50 bpm |
Placebo | Mortality at two weeks | Overall | 1% | 0.5% | Clinically significant hypotension | ||
| 3.1% | 2.3% | 15% | 9.7% | |||||||
| Vascular pts | ||||||||||
| Significant benefit | ||||||||||
| BBSA[3] 2007 |
224 patients *Spinal anesthesia *Vascular: 1% * RCRI > 2: 3% |
Bisoprolol * Started day of surgery Target HR: > 50bpm |
Placebo | Mortality at one year | 0.9 | 0.9 | 1.8% | 1.8% | Hypotension: | |
| 0% | 2.7% | |||||||||
| DIPOM[4] 2006 |
921 patients * All had diabetes * Vascular: 7% |
Metoprolol * Started 0-1 days preop * Target HR: >55 bpm |
Placebo | Mortality at a median of 18 months | 16% | 16% | 0.4% | 0% | Hypotension reported as an ADR | |
| 0.4% | 0.2% | |||||||||
|
MaVS |
496 patients * Vascular: 100% |
Metoprolol *Start: day of surgery * Target HR: > 50 bpm while awake; >45 bpm while asleep. |
Placebo | Hospital mortality | 0% | 1.6% | Not reported | Intraoperative hypotension treated | ||
| 46% | 34% | |||||||||
|
POBBLE |
103 patients * Vascular: 100% |
Metoprolol * Start with test dose one day preop * Target HR: > 50 bpm |
Placebo (anesthesiologists were not blinded) | Mortality at 30 days | 3% | 1% | 2% | 0% | Intraoperative inotropes given | |
| 92% | 64% | |||||||||
| 112 patients * Vascular surgery: 100% * Abnl stress echo: 100% |
Bisoprolol * Started a median of 37 days preop * Target HR: > 50 bpm |
Open label | Mortality at 30 days | 3.4 | 17.0 | Not reported | Discontinuation of study drug due to ADRs | |||
| 0% | 0% | |||||||||
| 200 patients * Vascular: 41% |
Atenolol * Target HR: > 55 bpm |
Placebo | 4% | 2% | Not reported | Discontinuation of study drug due to ADRs | ||||
| 0% | 0% | |||||||||
References
- ↑ 1.0 1.1 Dunkelgrun M, Boersma E, Schouten O, et al. (June 2009). "Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV)". Ann. Surg. 249 (6): 921–6. DOI:10.1097/SLA.0b013e3181a77d00. PMID 19474688. Research Blogging.
- ↑ 2.0 2.1 Devereaux PJ, Yang H, Yusuf S, et al. (May 2008). "Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial". Lancet 371 (9627): 1839–47. DOI:10.1016/S0140-6736(08)60601-7. PMID 18479744. Research Blogging.
- ↑ 3.0 3.1 Zaugg M, Bestmann L, Wacker J, et al. (July 2007). "Adrenergic receptor genotype but not perioperative bisoprolol therapy may determine cardiovascular outcome in at-risk patients undergoing surgery with spinal block: the Swiss Beta Blocker in Spinal Anesthesia (BBSA) study: a double-blinded, placebo-controlled, multicenter trial with 1-year follow-up". Anesthesiology 107 (1): 33–44. DOI:10.1097/01.anes.0000267530.62344.a4. PMID 17585213. Research Blogging.
- ↑ 4.0 4.1 Juul AB, Wetterslev J, Gluud C, et al. (June 2006). "Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial". BMJ 332 (7556): 1482. DOI:10.1136/bmj.332.7556.1482. PMID 16793810. PMC 1482337. Research Blogging.