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REDUCING GLOBAL PERIOPERATIVE RISK


This resource center is jointly hosted by The American Journal of Medicine,
The American Journal of Cardiology, and the Canadian Journal of Cardiology.

RISK PREVENTION

Key Highlights

  • POISE-2 PCI substudy is part of a large international, multicenter, randomized controlled trial with 2x2 factorial design involving 135 centers in 23 countries.
  • POISE-2 PCI included 470 patients who underwent noncardiac surgery with prior PCI.
  • Participants were randomized to aspirin versus placebo.

KEY FINDINGS

  • Clonidine had no effect on death or myocardial infarction. Clonidine was associated with an increased risk of non-fatal cardiac arrest and hypotension.
  • ASA had no effect on death or myocardial infarction, but increased the risk of major and life-threatening bleeding.
  • POISE 2 demonstrated that clinicians can improve outcomes by holding ASA during the perioperative period.
  • Perioperative hypotension and major/life threatening bleeding were independent predictors of perioperative myocardial infarction.

KEY FINDINGS

  • Metoprolol reduced the risk of myocardial infarction but increased the risk of death and stroke. The negative outcomes appeared to occur through an increase in hypotension on surgical floors.
  • The POISE trial highlighted the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, and the importance and need for large randomized trials in the perioperative setting.
  • Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol.

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Funding for this site was received from the PHRI via support from the Canadian Institutes of Health Research’s Strategy for
Patient Oriented Research, through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and Long-Term Care.