Clonidine in patients undergoing noncardiac surgery
| Title: | Clonidine in patients undergoing noncardiac surgery |
|---|---|
| Authors: | Devereaux PJ; Sessler DI; Leslie K; Kurz A; Mrkobrada M; Alonso Coello P; Villar JC; Sigamani A; Biccard BM; Meyhoff CS; Parlow JL; Guyatt G; Robinson A; Garg AX; Rodseth RN; Botto F; Lurati Buse G; Xavier D; Chan MT; Tiboni M; Cook D; Kumar PA; Forget P; Malaga G; Fleischmann E; Amir M; Eikelboom J; Mizera R; Torres D; Wang CY; Vanhelder T; Paniagua P; Berwanger O; Srinathan S; Graham M; Pasin L; Le Manach Y; Gao P; Pogue J; Whitlock R; Lamy A; Kearon C; Chow C; Pettit S; Chrolavicius S; Yusuf S; DeBeer J; Patel A; VanHelder T; Dechert W; Jackson P; Allard R; Dumerton Shore D; McCourt J; Jones PM; Lavi R; Lavi S; Moor R; Dresser GK; Gros ML; Schumann VC; Baur M; MacDonald C; Wirzba B; Regalado O; Srinathan SK; Ong DD; Todd A; Abbas S; Beattie WS; Chan VW; Chin KJ; Wijeysundera DN; Graham MM; Irwin M; Jacka M; El Beheiry H; McMullen SM; MacDonald P; Akhtar Z; Ayad S; Buttar M; Deroee A; Eshraghi Y; Fergany A; Finnigan P; Fu A; Grady M; Helper S; Hesler B; Honar H; Hutcherson M; Krebs V; Lee J; Malik M; Podolyak A; Salmasi V; Arora H; Coombs RF; Martinelli SM; Bergese SD; Melibary SB; Uribe AA; Jordan M; Miller SA; Cata JP; Nemergut EC; Candiotti KA; Memtsoudis SG; McKay RE; Montes FR; Parra GA; Rojas MF; Plata R; Vásquez SM; Sarquis T; Haider Z; Jane NB; Lanjewar PP; Rahate PV; Mehra BR; Premendaran B; Abraham V; George P; Kumar P; Gaikwad SB; Mohan NV; Sidhu G; Alvarez J; Gonzalez R; Maestre M; Popova E; Urrutia G; de Nadal M; González Suárez S; González Tallada A; Plou P; Mena E; Riveira C; del Valle S; Tena B; Lang SA; Ludbrook GL; Painter TW; Terblanche NC; Osborne C; Mahood JR; Myles PS; Sivalingam P; Riedel B; Elhalawani I; Drummond L; Mugabi A; Naidoo P; Myburgh AL; Porrill OS; Diedericks BJ; Turton EW; Bøgeskov M; Dahl RM; Madsen MV; Søndergaard ES; Bauer NE; Martinsen KR; Choi GY; Gin T; Ng SS; Bidgoli SJ; Van der Linden PJ; De Kock M; Kabon B; Luf F; Radonic M; Ishtiaq O; Safdar J; Acuna Villaorduna A; Barrionuevo P; Castaneda Guarderas A; Caballero JA; Lau VE; Aphang Lam MR; Lembo R; Jara X; Leon P; Ong G; Lee HS; Seeberger EE; Seeberger MD; Alfonsi P; Coriat P; Piriou V; Vizcaychipi MP; Rech RL; Bergo RR; Walker S; Rodseth R; LeManach Y; Díaz R; Cortés OL; Wetterslev J; Hoeft A; Wittmann M; Chan M; Landoni G; Conen D; Balaji P; Sovereign T; Blake L; Sephton J; Serra A; Agrippa C; Lawrence M; Biccard B; Gluud C; Baigent C; Karthikeyan G; Auerbach A; Beattie S; Buckley N; Douketis J; Gerstein H; Ghali W; Hart R; Hill M; McAlister F; McAuley D; Miller S; O'Donnell M; Pais P; Parlow J; Schricker T; Sessler D; Simunovic M; Teoh K; Walsh M; Wijeysundera D; Yang H; Alshalash S; Bessissow A; Duceppe E; Khalid Z; Khan J; Lauw M; Martinsen K; Neary J; Oczkowski W; Papina M; Seeberger M; Tandon V; Thomas S; Friedman L; Cheng D; Johnstone D; Lowenstein E; Roberts R.; GOSSETTI, Bruno |
| Contributors: | Devereaux, Pj; Sessler, Di; Leslie, K; Kurz, A; Mrkobrada, M; Alonso Coello, P; Villar, Jc; Sigamani, A; Biccard, Bm; Meyhoff, C; Parlow, Jl; Guyatt, G; Robinson, A; Garg, Ax; Rodseth, Rn; Botto, F; Lurati Buse, G; Xavier, D; Chan, Mt; Tiboni, M; Cook, D; Kumar, Pa; Forget, P; Malaga, G; Fleischmann, E; Amir, M; Eikelboom, J; Mizera, R; Torres, D; Wang, Cy; Vanhelder, T; Paniagua, P; Berwanger, O; Srinathan, S; Graham, M; Pasin, L; Le Manach, Y; Gao, P; Pogue, J; Whitlock, R; Lamy, A; Kearon, C; Chow, C; Pettit, S; Chrolavicius, S; Yusuf, S; Debeer, J; Patel, A; Dechert, W; Jackson, P; Allard, R; Dumerton Shore, D; Mccourt, J; Jones, Pm; Lavi, R; Lavi, S; Moor, R; Dresser, Gk; Gros, Ml; Schumann, Vc; Baur, M; Macdonald, C; Wirzba, B; Regalado, O; Srinathan, Sk; Ong, Dd; Todd, A; Abbas, S; Beattie, W; Chan, Vw; Chin, Kj; Wijeysundera, Dn; Graham, Mm; Irwin, M; Jacka, M; El Beheiry, H; Mcmullen, Sm; Macdonald, P; Akhtar, Z; Ayad, S; Buttar, M; Deroee, A; Eshraghi, Y; Fergany, A; Finnigan, P; Fu, A; Grady, M; Helper, S; Hesler, B; Honar, H; Hutcherson, M; Krebs, V; Lee, J |
| Publisher Information: | Massachusetts Medical Society:860 Winter Street:Waltham, MA 02451:(800)843-6356, (781)893-3800, EMAIL: nejmcust@mms.org, INTERNET: http://www.massmed.org/, Fax: (781)647-5785, (781)893-7368 |
| Publication Year: | 2014 |
| Collection: | Sapienza Università di Roma: CINECA IRIS |
| Description: | BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P |
| Document Type: | article in journal/newspaper |
| File Description: | STAMPA |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/24679061; info:eu-repo/semantics/altIdentifier/wos/WOS:000334601600007; volume:370(16); issue:2014 Apr 17; firstpage:1504; lastpage:1513; numberofpages:10; journal:NEW ENGLAND JOURNAL OF MEDICINE; http://hdl.handle.net/11573/558012 |
| DOI: | 10.1056/NEJMoa1401106 |
| Availability: | http://hdl.handle.net/11573/558012; https://doi.org/10.1056/NEJMoa1401106 |
| Accession Number: | edsbas.3586424E |
| Database: | BASE |