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Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery The Stop-or-Not Randomized Clinical Trial

dc.rights.licenseopenen_US
dc.contributor.authorLEGRAND, Matthieu
dc.contributor.authorFALCONE, Jérémy
dc.contributor.authorCHOLLEY, Bernard
dc.contributor.authorCHARBONNEAU, Hélène
dc.contributor.authorDELAPORTE, Amélie
dc.contributor.authorLEMOINE, Adrien
dc.contributor.authorGAROT, Matthias
dc.contributor.authorJOOSTEN, Alexandre
dc.contributor.authorMEISTELMAN, Claude
dc.contributor.authorCHERON-LEROY, Delphine
dc.contributor.authorRIVES, Jean-Philippe
dc.contributor.authorPASTENE, Bruno
hal.structure.identifierImmunology from Concept and Experiments to Translation = Immunologie Conceptuelle, Expérimentale et Translationnelle [ImmunoConcept]
dc.contributor.authorDEWITTE, Antoine
dc.contributor.authorSIGAUT, Stéphanie
dc.contributor.authorDES DESERTS, Marc Danguy
dc.contributor.authorTRUC, Cyrille
dc.contributor.authorBOISSON, Matthieu
dc.contributor.authorLASOCKI, Sigismond
dc.contributor.authorCUVILLON, Philippe
dc.contributor.authorSCHIFF, Ugo
dc.contributor.authorJABER, Samir
dc.contributor.authorLE GUEN, Morgan
dc.contributor.authorCAILLARD, Anaïs
dc.contributor.authorBAR, Stéphane
dc.contributor.authorDE SOUZA NETO, Edmundo Pereira
dc.contributor.authorCOLAS, Vincent
dc.contributor.authorDIMACHE, Florin
dc.contributor.authorGIRARDOT, Thibaut
dc.contributor.authorJOZEFOWICZ, Elsa
dc.contributor.authorVIQUESNEL, Simon
dc.contributor.authorBERTHIER, Francis
dc.contributor.authorVICAUT, Eric
dc.contributor.authorGAYAT, Etienne
dc.date.accessioned2025-01-22T14:26:01Z
dc.date.available2025-01-22T14:26:01Z
dc.date.issued2024-08
dc.identifier.urihttps://oskar-bordeaux.fr/handle/20.500.12278/204477
dc.description.abstractEnIMPORTANCE 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.
dc.language.isoENen_US
dc.title.enContinuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery The Stop-or-Not Randomized Clinical Trial
dc.typeArticle de revueen_US
dc.identifier.doi10.1001/jama.2024.17123en_US
dc.subject.halSciences du Vivant [q-bio]/Immunologieen_US
dc.identifier.pubmed39212270en_US
bordeaux.journalJamaen_US
bordeaux.hal.laboratoriesImmunoConcEpT - UMR 5164en_US
bordeaux.institutionUniversité de Bordeauxen_US
bordeaux.institutionCNRSen_US
bordeaux.peerReviewedouien_US
bordeaux.inpressnonen_US
hal.popularnonen_US
hal.audienceInternationaleen_US
hal.exportfalse
dc.rights.ccPas de Licence CCen_US
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