| Title: |
Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery |
| Authors: |
Legrand, Matthieu; Falcone, Jérémy; Cholley, Bernard; Charbonneau, Hélène; Delaporte, Amélie; Lemoine, Adrien; Garot, Matthias; Joosten, Alexandre; Meistelman, Claude; Cheron-Leroy, Delphine; Rives, Jean-Philippe; Pastene, Bruno; Dewitte, Antoine; Sigaut, Stéphanie; Danguy Des Deserts, Marc; Truc, Cyrille; Boisson, Matthieu; Lasocki, Sigismond; Cuvillon, Philippe; Schiff, Ugo; Jaber, Samir; Le Guen, Morgan; Caillard, Anaïs; Bar, Stéphane; Pereira de Souza Neto, Edmundo; Colas, Vincent; Dimache, Florin; Girardot, Thibaut; Jozefowicz, Elsa; Viquesnel, Simon; Berthier, Francis; Vicaut, Eric; Gayat, Etienne; Monziols, Simon; Defaye, Mylene; Camus, Thibault; Robin, Jean-Jacques; Ouattara, Alexandre; Fetita, Ioana; Joannes-Boyau, Olivier; Bonnardel, Eline; Bouquerel, Rémi; Strzelecki, Antoine; Fayon, Thibaut; Pelletier, Christophe; Le Gaillard, Benjamin; Amoussou, Géraud; El Bouyousfi, Maalik; Ganascia, Bruno; Butrulle, Calliope; Gergaud, Soizic; Habrial, Pierre; Pessiot, Solène; Samson, Emmanuel; Wolff, Caroline; Stankova, Nevena; Aouati, Farida; Kavafyan, Juliette; Suparschi, Vlad; Longrois, Dan; Le Roy, Julie; Rossignol, Benoit; Huet, Olivier; Boisson, Christophe; Bonnin, Pierre Olivier; Dhaouadi, Mohamed; Gardes, Ghislaine; Perin, Mikael; Brunet, Sophie; Gricourt, Yann; Fischer, Marc-Olivier; Debroczi, Stéphane; Retournay, Lucie; Strub, Pierre; Vivin, Patrice; Dupays, Rachel; Kerforne, Thomas; Vianet, Gabriel; Manzano, Virginie; Noll, Eric; Ludes, Pierre-Olivier; Chamaraux-Tran, Thien-Nga; Cirenei, Cédric; Hamroun, Djihad; Lebas, Benoit; Andrieu, Grégoire Andrieu; Etienne, Vincent; Cinotti, Raphaël; Simon, Natacha; Frasca, Denis; Beloeil, Hélène; Le Gall, Amandine; Techev, Petyo; Meuret, Ludovic; Joffre, Jérémie; Dupont, Hervé; Charbit, Beny; Davy, Arthur; Lobo, David; Devys, Jean-Michel; Soria, Benjamin; Cholet, Clémentine; Motamed, Cyrus; Wyniecki, Anne; Billard, Valérie; Demiri, Migena; Millet, Clement; Degoul, Samuel; Canevet, Christophe; Mounier, Céline; Desrumaux, Flavie; Martinez, Julia; Texier, Claire; Voisin, Benoit; Dubreuil, Guillaume; de Montblanc, Jacques; Mengelle, Claire; Ruscio, Laura; Futier, Emmanuel; Fayon, Julie; Baietto, Benoit; Vignaud, Marie; Munier, Yoann; Paquette, Bertille; Saptefrat, Diana; Machroub, Zakia; Aubert, Jean-Sébastien; Abi Abdallah, Georges; Polge, Nicolas; Dachraoui, Najla; Godier, Anne; Zlotnik, Diane; Nougue, Hélène; Clausse, Darless; Ma, Sabrina; Salami-Adjavon, Sherifatou; Rossignol, Patrick; Barthélémy, Romain; Logeart, Damien; Reiner, Peggy; Pautrat, Karine; Hong, Alex; Coroir, Marine; Mayeur, Claire; Thes, Jacques; Laverdure, Florent; Seri, Sofiane; Bercan, Violeta; Ionescu, Cristian Radu; Gonnet Pinton, Caroline; Leone, Marc; Lesavre, Nathalie; Chatelon, Jeanne; Poirier, Marion; Rivory, Adrien; Roullet, Stéphanie; Coeckelenbergh, Sean; Toubal, Leila; Ramadan, Joanna; Nouette-Gaulain, Karine; Ralec, Bruno; Thill, Chloé; Giacardi, Christophe; Montelescaut, Etienne; Aries, Philippe; Tavernier, Benoît; Bellet, Julie; Delassus, Romain; Tribouillard, Hélène; Verzilli, Daniel; Millot, Alice; de Jong, Audrey; Geniez, Marie; Marre, Virginie; Penne, Michaëla; Pouzeratte, Yvan; Rao, Guillaume; Coutrot, Maxime; Blet, Alice; Plaud, Benoit; Basto, Emmanuel; Ponsin, Mathilde; Becq, Marie-Christine; Chaussard, Maïté; Ntahe, Aristide; Depret, François; Guillemet, Lucie; Valent, Arnaud; Flores, Lyse; Burey, Julien; Feray, Sarah; Elmaleh, Yoann; Dupeyrat, Sophie; Baury, Thomas; Taconet, Clémentine; Rimmele, Thomas; Mazocky, Elodie; Parrouffe, Marie Luce; Jadaud, Catherine; Abrard, Stanislas; Tronche, Pierre-Antoine; Vial, Arthur; Aka, Emma; Bellocq, Anne-Sophie; Carabalona, Jean-François; Fayard, Blandine; Guyader, Jean Marie; Huriaux, Letitia; Millot, Ingrid; Lamblin, Antoine; Dutour, Marine; Roukhomovsky-Moretti, Mathilde; Meuret, Pascal; Omrani, Nadir; Raymond, Barnabé; Roy, Clemence; Sigwalt, Florent; Merindol, Xavier; Desmard, Mathieu; Bourreau, Louis; Allain, Pierre-Antoine; Dei Svaldi, Charlotte; Alexander, Brenton |
| Contributors: |
University of California San Francisco (UC San Francisco); University of California (UC); Hôpital Claude Huriez Lille; Centre Hospitalier Régional Universitaire CHU Lille (CHRU Lille); Hôpital Européen Georges Pompidou APHP (HEGP); Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO); Clinique Pasteur Toulouse; Hôpital Marie-Lannelongue; CHU Tenon AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU); Sorbonne Université (SU); Hôpital Bicêtre AP-HP, Le Kremlin-Bicêtre; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy); Hopital Saint-Louis AP-HP (AP-HP); Département d'anesthésie Gustave Roussy; Institut Gustave Roussy (IGR); Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN); Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE); Immunology from Concept and Experiments to Translation = Immunologie Conceptuelle, Expérimentale et Translationnelle (ImmunoConcept); Université de Bordeaux (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS); Hôpital Beaujon AP-HP; Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO); Université de Brest (UBO EPE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM); Université de Brest (UBO EPE)-Université de Brest (UBO EPE); Hôpital d'Instruction des Armées Clermont Tonnerre; Service de Santé des Armées; Hôpital Edouard Herriot CHU - HCL; Hospices Civils de Lyon (HCL); Pharmacologie des anti-infectieux et antibiorésistance U 1070 (PHAR2 Poitiers ); Université de Poitiers = University of Poitiers (UP)-Institut National de la Santé et de la Recherche Médicale (INSERM); Centre hospitalier universitaire de Poitiers = Poitiers University Hospital (CHU de Poitiers La Milétrie ); Centre Hospitalier Universitaire d'Angers (CHU Angers); Centre Hospitalier Universitaire de Nîmes (CHU Nîmes); Initial MAnagement and prevention of acute orGan failures IN critically ill patiEnts (IMAGINE); Université de Montpellier (UM); Faculté de Médecine - Clermont-Auvergne (FM - UCA); Université Clermont Auvergne (UCA); Physiologie & médecine expérimentale du Cœur et des Muscles U 1046 (PhyMedExp); Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM); Centre Hospitalier Régional Universitaire Montpellier (CHRU Montpellier); Hôpital Foch Suresnes; Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST); Optimisation des régulations physiologiques (ORPHY (EA 4324)); Université de Brest (UBO EPE)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Institut Brestois Santé Agro Matière (IBSAM); CHU Amiens-Picardie; Simplification des soins chez les patients complexes - UR UPJV 7518 (SSPC); Université de Picardie Jules Verne (UPJV); Centre hospitalier de Montauban (CH Montauban); Hôpital Saint Philibert Lomme; Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL); Université catholique de Lille (UCL)-Université catholique de Lille (UCL); Centre Hospitalier Universitaire Strasbourg (CHU Strasbourg); Hôpitaux Universitaires de Strasbourg (HUS); Centre hospitalier de Valence; Hôpital Roger Salengro Lille; Service d'anesthésie réanimation chirurgicale Rennes; Université de Rennes (UR)-Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital Pontchaillou; Centre d'Investigation Clinique de Besançon (Inserm CIC 1431); Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Établissement Français du Sang Bourgogne-Franche-Comté Besançon (EFS BFC - Besançon); Établissement Français du Sang La Plaine Saint-Denis (EFS)-Établissement Français du Sang La Plaine Saint-Denis (EFS)-Université de Franche-Comté (UFC); Université Bourgogne Franche-Comté COMUE (UBFC)-Université Bourgogne Franche-Comté COMUE (UBFC); Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris; Cardiovascular and Renal Clinical Trialists Vandoeuvre-les-Nancy (INI-CRCT); Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu Nancy; Service d'Anesthésie-Réanimation AP-HP Hôpitaux Saint-Louis Lariboisière; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal APHP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Cité (UPCité); Marqueurs cardiovasculaires en situation de stress (MASCOT (UMR_S_942 / U942)); Institut National de la Santé et de la Recherche Médicale (INSERM)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal Paris; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord; Hopital d'instruction des armées Sainte-Anne Toulon (HIA) |
| Source: |
ISSN: 2380-6583. |
| Publisher Information: |
CCSD; American Medical Association |
| Publication Year: |
2024 |
| Collection: |
Université de Poitiers: Publications de nos chercheurs.ses (HAL) |
| Subject Terms: |
MESH: Aged; MESH: Angiotensin Receptor Antagonists* / administration & dosage; MESH: Postoperative Complications* / etiology; MESH: Length of Stay; MESH: Angiotensin Receptor Antagonists* / adverse effects; MESH: Male; MESH: Middle Aged; MESH: Postoperative Complications* / epidemiology; MESH: Postoperative Complications* / prevention & control; MESH: Preoperative Care / methods; MESH: Angiotensin-Converting Enzyme Inhibitors* / adverse effects; MESH: Renin-Angiotensin System / drug effects; MESH: Hypotension / prevention & control; MESH: Surgical Procedures; Operative* / adverse effects; MESH: Time Factors; MESH: Angiotensin-Converting Enzyme Inhibitors* / administration & dosage; MESH: Female; MESH: Hospital Mortality; MESH: Intraoperative Complications / etiology; MESH: Humans; MESH: Hypotension / epidemiology; MESH: Hypotension / etiology; MESH: Intraoperative Complications / epidemiology; MESH: Intraoperative Complications / prevention & control; [SDV]Life Sciences [q-bio] |
| Description: |
International audience ; 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 ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/39212270; PUBMED: 39212270; PUBMEDCENTRAL: PMC11365013 |
| DOI: |
10.1001/jama.2024.17123 |
| Availability: |
https://hal.science/hal-04683070; https://hal.science/hal-04683070v1/document; https://hal.science/hal-04683070v1/file/2024%20%20Legrand%20et%20al.,%20Continuation%20vs%20Discontinuation.pdf; https://doi.org/10.1001/jama.2024.17123 |
| Rights: |
https://about.hal.science/hal-authorisation-v1/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.FC02DE57 |
| Database: |
BASE |