Surgery News - February 2009 - (Page 17) FEBRUARY 2009 • SURGERY NEWS VASCULAR 17 Presurgical Bisoprolol Triggers No Excess Strokes BY MITCHEL L. ZOLER Else vier Global Medical Ne ws M U N I C H — Patients undergoing noncardiac surgery benefited from pre- and postoperative treatment with the β-blocker bisoprolol and had no excess risk for stroke, based on an analysis of about 2,000 patients who had been enrolled in three separate studies. This finding contrasts with results from a major trial first reported in November 2007 and published last May. Results from the Perioperative Ischemic Evaluation (POISE) trial found that starting the β-blocker metoprolol, the extended-release formulation, just hours before noncardiac surgery and continued for a month was linked with about a twofold increase in strokes (Lancet 2008;371:1839-47). The reason for this difference in stroke rates is unknown, but one speculative explanation is that the studies ed with bisoprolol ( J. Am. Coll. Card. 2006;48:964-9). DECREASE-IV included about 530 patients treated with bisoprolol and a similar number treated with placebo. Dr. Schouten presented the findings in a poster at the meeting. Dr. Schouten’s analysis showed that, among patients not on a β-blocker, the incidence of stroke was 0.4% in the DECREASE studies and 0.5% in the POISE study. Among patients on a β-blocker, the stroke rate was 0.5% in the DECREASE studies and 1.0% in POISE, a statistically significant difference. In a multivariate analysis of the DECREASE results that controlled for baseline differences among patients, those who were treated with bisoprolol had no significant increase in strokes, compared with patients not treated with bisoprolol, Dr. Schouten said. The DECREASE-IV results presented at the meeting also highlighted the benefit from bisoprolol treatment in cutting the rate of death and nonfatal myocar- dial infarction in patients undergoing noncardiac vascular surgery. The combined rate of death and MI during the first 30 days following surgery was about 2% in patients treated with bisoprolol and about 6% in those on placebo, reported Dr. Martin Dunkelgrun and his associates from Erasmus. The DECREASE studies did not receive any commercial funding. Dr. Schouten and associates at Erasmus had no disclosures relevant to these studies. A PREVIOUS STUDY RAISED DOUBTS, BUT THE NEW RESULTS FROM THE BISOPROLOL ANALYSIS PROVIDE REASSURANCE THAT THIS PRESURGICAL REGIMEN IS SAFE. using bisoprolol started patients on a low-dose regimen weeks before their surgery and the dosage never rose much higher for all patients. In the metoprolol study, patients were started on the maximum recommended therapeutic dose and underwent surgery just hours after treatment began, Dr. Olaf Schouten said at the annual congress of the European Society of Cardiology. The results from the metoprolol study raised doubts about the safety of starting patients on a β-blocker before surgery, but the new results from the bisoprolol analysis provide reassurance that this presurgical regimen is safe, said Dr. Schouten, a vascular surgeon at Erasmus Medical Center in Rotterdam, the Netherlands. “We continue to use bisoprolol starting about 30 days before surgery. We have not changed our β-blocker guidelines,” he said. Their protocol involves starting patients on a 2.5-mg/day dosage of bisoprolol, which is about 10%-15% of the maximum recommended dose. One day prior to surgery, the dosage is adjusted to achieve a target heart rate of 6065 beats per minute. In most patients the 2.5-mg/day dosage is already maintaining this heart rate; in a minority, the dosage is raised to 3.75 mg or 5 mg/day, still substantially below the maximum dose, Dr. Schouten said. The data reviewed by Dr. Schouten were collected in three studies from the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) series run at Erasmus. The DECREASE-I study included 59 patients treated with bisoprolol and 53 who did not receive a β-blocker (N. Engl. J. Med. 1999;341:1789-94). DECREASE-II included 1,476 patients who were all treat- Membership in the American College of Surgeons? H E R E ’ S W H Y I T ’ S I M P O R TA N T: AS A BODY REPRESENTING ALL OF SURGERY, THE COLLEGE: • Provides a cohesive voice addressing societal issues related to surgery. • Is working toward having an increasingly proactive and timely voice in setting a national tone and agenda with regard to health care. • Is dedicated to promoting the highest standards of surgical care through education of and advocacy for its Fellows and their patients. • Serves as a national forum through which surgeons can reinforce the values and ethics that traditionally have characterized the surgical profession. HERE ARE SOME OF THE MANY BENEFITS BEING A MEMBER OF THE COLLEGE AFFORDS YOU: • Free preregistration at the Clinical Congress • Access to the College’s free coding consultation hotline • Subscription to ACS NewsScope, the College’s weekly electronic newsletter • Subscription to the Bulletin of the American College of Surgeons • Subscription to the Journal of the American College of Surgeons • Access to all College-sponsored insurance, credit card, and other helpful programs • Free posting of resume on ACS Career Opportunities • Access to Surgeons Diversified Investment Fund THERE IS STRENGTH IN NUMBERS. Our members represent every specialty, practice setting, and stage of practice. Their views and concerns are helping to shape the College’s agenda for the future. If you aren’t a member of the American College of Surgeons, apply for Fellowship today. If you are already a member, maintain that status and consider getting involved in the work of the College. Only by banding together and using our collective strength can we bring about positive change for our patients and ourselves—and for surgeons of the future. Information on becoming a member of the College and an application form are available online at w w w.f ac s .org/dept /fellowship/index .html or contact Cynthia Hicks, Credentials Section, Division of Member Services, via phone at 1-800/293-9623, or via e-mail at chicks@facs.org. http://www.facs.org/dept/fellowship/index.html http://www.facs.org/dept/fellowship/index.html
Table of Contents Feed for the Digital Edition of Surgery News - February 2009 Surgery News - February 2009 Contents The 20/20 Vision ICD-10 Looms News From the College: MedPAC Flak Oncology: Best for Breast General Surgery: Weighty Problem Surgery News - February 2009 Surgery News - February 2009 - Contents (Page 1) Surgery News - February 2009 - Contents (Page 2) Surgery News - February 2009 - Contents (Page 3) Surgery News - February 2009 - Contents (Page 4) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 5) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 6) Surgery News - February 2009 - The 20/20 Vision ICD-10 Looms (Page 7) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 8) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 9) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 10) Surgery News - February 2009 - News From the College: MedPAC Flak (Page 11) Surgery News - February 2009 - Oncology: Best for Breast (Page 12) Surgery News - February 2009 - Oncology: Best for Breast (Page 13) Surgery News - February 2009 - Oncology: Best for Breast (Page 14) Surgery News - February 2009 - Oncology: Best for Breast (Page 15) Surgery News - February 2009 - Oncology: Best for Breast (Page 16) Surgery News - February 2009 - Oncology: Best for Breast (Page 17) Surgery News - February 2009 - Oncology: Best for Breast (Page 18) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 19) Surgery News - February 2009 - General Surgery: Weighty Problem (Page 20)
For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.