Impact of Renin-Angiotensin System Inhibitor Discontinuation on Post-Operative Outcomes in Non-Cardiac Surgery
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Reviewed & Translated by Dat Tien Nguyen, B.A, ScM.
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Posted on October 28th, 2024
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Renin-angiotensin system inhibitors are a widely prescribed class of antihypertensive drugs. It has been suggested that continuing these medications before surgery might lead to complications due to the risk of hypotension, which can result in acute kidney injury. On the other hand, discontinuing the therapy could cause uncontrolled hypertension and complications during surgery. A recent study published in the Journal of the American Medical Association evaluated the risk of post-operative complications associated with the discontinuation of renin-angiotensin system inhibitor therapy before surgery.
The clinical trial was conducted in France with funding obtained from the French Ministry of Health. The study involved 1,107 patients with a median age of 68 who had been taking angiotensin receptor blockers or angiotensin-converting enzyme inhibitors for the prior three months. These patients were scheduled for non-cardiac surgeries lasting a median of 180 minutes. One-third underwent abdominal surgery, 15% had thoracic procedures, and approximately 10% had orthopedic, urological, or vascular operations. Participants were randomly assigned to either discontinue renin-angiotensin system inhibitors (RASI) 48 hours before surgery or continue the medication as usual. The participants’ health were monitored for 28 days post-operation. The study found that stopping renin-angiotensin system inhibitors did not significantly impact mortality rates or the risk of post-operative cardiovascular and non-cardiovascular complications. However, those who discontinued RASI had a 78% higher risk of developing hypotension requiring vasopressors. No significant differences were observed between the groups regarding ICU admission rates or hospital stay duration.
The clinical trial was conducted in France with funding obtained from the French Ministry of Health. The study involved 1,107 patients with a median age of 68 who had been taking angiotensin receptor blockers or angiotensin-converting enzyme inhibitors for the prior three months. These patients were scheduled for non-cardiac surgeries lasting a median of 180 minutes. One-third underwent abdominal surgery, 15% had thoracic procedures, and approximately 10% had orthopedic, urological, or vascular operations. Participants were randomly assigned to either discontinue renin-angiotensin system inhibitors (RASI) 48 hours before surgery or continue the medication as usual. The participants’ health were monitored for 28 days post-operation. The study found that stopping renin-angiotensin system inhibitors did not significantly impact mortality rates or the risk of post-operative cardiovascular and non-cardiovascular complications. However, those who discontinued RASI had a 78% higher risk of developing hypotension requiring vasopressors. No significant differences were observed between the groups regarding ICU admission rates or hospital stay duration.