Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery
Matthieu Legrand
,
Jérémy Falcone
,
Bernard Cholley
,
Hélène Charbonneau
,
Amélie Delaporte
,
Adrien Lemoine
,
Matthias Garot
,
Alexandre Joosten
,
Claude Meistelman
,
Delphine Cheron-Leroy
,
Jean-Philippe Rives
,
Bruno Pastene
,
Antoine Dewitte
,
Stéphanie Sigaut
,
Marc Danguy Des Deserts
(1, 2)
,
Cyrille Truc
,
Matthieu Boisson
,
Sigismond Lasocki
,
Philippe Cuvillon
,
Ugo Schiff
,
Samir Jaber
(3, 4)
,
Morgan Le Guen
,
Anaïs Caillard
,
Stéphane Bar
(5, 6)
,
Edmundo Pereira de Souza Neto
,
Vincent Colas
,
Florin Dimache
,
Thibaut Girardot
,
Elsa Jozefowicz
,
Simon Viquesnel
,
Francis Berthier
,
Eric Vicaut
,
Etienne Gayat
,
Simon Monziols
,
Mylene Defaye
,
Thibault Camus
,
Jean-Jacques Robin
,
Alexandre Ouattara
,
Ioana Fetita
,
Olivier Joannes-Boyau
,
Eline Bonnardel
,
Rémi Bouquerel
,
Antoine Strzelecki
,
Thibaut Fayon
,
Christophe Pelletier
,
Benjamin Le Gaillard
,
Thibaut Girardot
,
Géraud Amoussou
,
Maalik El Bouyousfi
,
Bruno Ganascia
,
Calliope Butrulle
,
Soizic Gergaud
,
Pierre Habrial
,
Solène Pessiot
,
Emmanuel Samson
,
Caroline Wolff
,
Nevena Stankova
,
Farida Aouati
,
Juliette Kavafyan
,
Vlad Suparschi
,
Dan Longrois
,
Julie Le Roy
,
Benoit Rossignol
,
Olivier Huet
,
Christophe Boisson
,
Pierre Olivier Bonnin
,
Mohamed Dhaouadi
,
Ghislaine Gardes
,
Mikael Perin
,
Sophie Brunet
,
Yann Gricourt
,
Marc-Olivier Fischer
,
Stéphane Debroczi
,
Lucie Retournay
,
Pierre Strub
,
Patrice Vivin
,
Rachel Dupays
,
Thomas Kerforne
,
Gabriel Vianet
,
Virginie Manzano
,
Eric Noll
,
Pierre-Olivier Ludes
,
Thien-Nga Chamaraux-Tran
,
Cédric Cirenei
,
Djihad Hamroun
,
Benoit Lebas
,
Grégoire Andrieu Andrieu
,
Vincent Etienne
,
Raphaël Cinotti
,
Natacha Simon
,
Denis Frasca
,
Hélène Beloeil
,
Amandine Le Gall
,
Petyo Techev
,
Ludovic Meuret
,
Jérémie Joffre
,
Hervé Dupont
,
Beny Charbit
,
Arthur Davy
,
David Lobo
,
Jean-Michel Devys
,
Benjamin Soria
,
Clémentine Cholet
,
Cyrus Motamed
,
Anne Wyniecki
,
Valérie Billard
,
Migena Demiri
,
Clement Millet
,
Samuel Degoul
,
Christophe Canevet
,
Céline Mounier
,
Flavie Desrumaux
,
Julia Martinez
,
Claire Texier
,
Benoit Voisin
,
Guillaume Dubreuil
,
Jacques de Montblanc
,
Claire Mengelle
,
Laura Ruscio
,
Emmanuel Futier
,
Julie Fayon
,
Benoit Baietto
,
Marie Vignaud
,
Yoann Munier
,
Bertille Paquette
,
Diana Saptefrat
,
Zakia Machroub
,
Jean-Sébastien Aubert
,
Georges Abi Abdallah
,
Nicolas Polge
,
Najla Dachraoui
,
Anne Godier
,
Diane Zlotnik
,
Hélène Nougue
,
Darless Clausse
,
Sabrina Ma
,
Sherifatou Salami-Adjavon
,
Patrick Rossignol
,
Francis Berthier
,
Romain Barthélémy
,
Gabriel Vianet
,
Damien Logeart
,
Peggy Reiner
,
Karine Pautrat
,
Alex Hong
,
Marine Coroir
,
Claire Mayeur
,
Jacques Thes
,
Florent Laverdure
,
Sofiane Seri
,
Violeta Bercan
,
Cristian Radu Ionescu
,
Caroline Gonnet Pinton
,
Marc Leone
,
Nathalie Lesavre
,
Jeanne Chatelon
,
Marion Poirier
,
Adrien Rivory
,
Stéphanie Roullet
,
Sean Coeckelenbergh
,
Leila Toubal
,
Joanna Ramadan
,
Karine Nouette-Gaulain
,
Bruno Ralec
(2)
,
Chloé Thill
(2)
,
Christophe Giacardi
(2)
,
Etienne Montelescaut
(7)
,
Philippe Aries
(2)
,
Benoît Tavernier
,
Julie Bellet
,
Romain Delassus
,
Hélène Tribouillard
,
Daniel Verzilli
,
Alice Millot
,
Audrey de Jong
(3, 4)
,
Marie Geniez
,
Virginie Marre
,
Michaëla Penne
,
Yvan Pouzeratte
,
Guillaume Rao
,
Maxime Coutrot
,
Alice Blet
,
Benoit Plaud
,
Emmanuel Basto
,
Mathilde Ponsin
,
Marie-Christine Becq
,
Maïté Chaussard
,
Aristide Ntahe
,
François Depret
,
Lucie Guillemet
,
Arnaud Valent
,
Lyse Flores
,
Julien Burey
,
Sarah Feray
,
Yoann Elmaleh
,
Sophie Dupeyrat
,
Thomas Baury
,
Clémentine Taconet
,
Thomas Rimmele
,
Elodie Mazocky
,
Marie Luce Parrouffe
,
Catherine Jadaud
,
Stanislas Abrard
,
Pierre-Antoine Tronche
,
Arthur Vial
,
Emma Aka
,
Anne-Sophie Bellocq
,
Jean-François Carabalona
,
Blandine Fayard
,
Jean Marie Guyader
,
Letitia Huriaux
,
Ingrid Millot
,
Antoine Lamblin
,
Marine Dutour
,
Mathilde Roukhomovsky-Moretti
,
Pascal Meuret
,
Nadir Omrani
,
Barnabé Raymond
,
Clemence Roy
,
Florent Sigwalt
,
Xavier Merindol
,
Mathieu Desmard
,
Louis Bourreau
,
Pierre-Antoine Allain
,
Charlotte Dei Svaldi
,
Brenton Alexander
1
GETBO -
Groupe d'Etude de la Thrombose de Bretagne Occidentale
2 Hôpital d'Instruction des Armées Clermont Tonnerre
3 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
4 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
5 CHU Amiens-Picardie
6 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
7 HIA - Hopital d'instruction des armées Sainte-Anne [Toulon]
2 Hôpital d'Instruction des Armées Clermont Tonnerre
3 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
4 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
5 CHU Amiens-Picardie
6 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
7 HIA - Hopital d'instruction des armées Sainte-Anne [Toulon]
Matthieu Legrand
- Function : Author
Jérémy Falcone
- Function : Author
Bernard Cholley
- Function : Author
Hélène Charbonneau
- Function : Author
Amélie Delaporte
- Function : Author
Adrien Lemoine
- Function : Author
Matthias Garot
- Function : Author
Alexandre Joosten
- Function : Author
Claude Meistelman
- Function : Author
Delphine Cheron-Leroy
- Function : Author
Jean-Philippe Rives
- Function : Author
Bruno Pastene
- Function : Author
Antoine Dewitte
- Function : Author
Stéphanie Sigaut
- Function : Author
Marc Danguy Des Deserts
- Function : Author
- PersonId : 745939
- IdHAL : marc-danguy-des-deserts
- ORCID : 0000-0002-0185-9955
- IdRef : 176569480
Cyrille Truc
- Function : Author
Matthieu Boisson
- Function : Author
- PersonId : 793363
- ORCID : 0000-0003-3667-5782
- IdRef : 163923787
Sigismond Lasocki
- Function : Author
Philippe Cuvillon
- Function : Author
Ugo Schiff
- Function : Author
Morgan Le Guen
- Function : Author
Anaïs Caillard
- Function : Author
Stéphane Bar
- Function : Author
- PersonId : 1155746
- ORCID : 0000-0002-4630-5833
- IdRef : 196213444
Edmundo Pereira de Souza Neto
- Function : Author
Vincent Colas
- Function : Author
Florin Dimache
- Function : Author
Thibaut Girardot
- Function : Author
Elsa Jozefowicz
- Function : Author
Simon Viquesnel
- Function : Author
Francis Berthier
- Function : Author
Eric Vicaut
- Function : Author
Etienne Gayat
- Function : Author
Simon Monziols
- Function : Author
Mylene Defaye
- Function : Author
Thibault Camus
- Function : Author
Jean-Jacques Robin
- Function : Author
Alexandre Ouattara
- Function : Author
Ioana Fetita
- Function : Author
Olivier Joannes-Boyau
- Function : Author
Eline Bonnardel
- Function : Author
Rémi Bouquerel
- Function : Author
Antoine Strzelecki
- Function : Author
Thibaut Fayon
- Function : Author
Christophe Pelletier
- Function : Author
Benjamin Le Gaillard
- Function : Author
Thibaut Girardot
- Function : Author
Géraud Amoussou
- Function : Author
Maalik El Bouyousfi
- Function : Author
Bruno Ganascia
- Function : Author
Calliope Butrulle
- Function : Author
Soizic Gergaud
- Function : Author
Pierre Habrial
- Function : Author
Solène Pessiot
- Function : Author
Emmanuel Samson
- Function : Author
Caroline Wolff
- Function : Author
Nevena Stankova
- Function : Author
Farida Aouati
- Function : Author
Juliette Kavafyan
- Function : Author
Vlad Suparschi
- Function : Author
Dan Longrois
- Function : Author
Julie Le Roy
- Function : Author
Benoit Rossignol
- Function : Author
Olivier Huet
- Function : Author
Christophe Boisson
- Function : Author
Pierre Olivier Bonnin
- Function : Author
Mohamed Dhaouadi
- Function : Author
Ghislaine Gardes
- Function : Author
Mikael Perin
- Function : Author
Sophie Brunet
- Function : Author
Yann Gricourt
- Function : Author
Marc-Olivier Fischer
- Function : Author
Stéphane Debroczi
- Function : Author
Lucie Retournay
- Function : Author
Pierre Strub
- Function : Author
Patrice Vivin
- Function : Author
Rachel Dupays
- Function : Author
Thomas Kerforne
- Function : Author
- PersonId : 1364278
- ORCID : 0000-0002-0611-4100
- IdRef : 172292212
Gabriel Vianet
- Function : Author
Virginie Manzano
- Function : Author
Eric Noll
- Function : Author
Pierre-Olivier Ludes
- Function : Author
Thien-Nga Chamaraux-Tran
- Function : Author
Cédric Cirenei
- Function : Author
Djihad Hamroun
- Function : Author
Benoit Lebas
- Function : Author
Grégoire Andrieu Andrieu
- Function : Author
Vincent Etienne
- Function : Author
Raphaël Cinotti
- Function : Author
Natacha Simon
- Function : Author
Denis Frasca
- Function : Author
Hélène Beloeil
- Function : Author
Amandine Le Gall
- Function : Author
Petyo Techev
- Function : Author
Ludovic Meuret
- Function : Author
Jérémie Joffre
- Function : Author
Hervé Dupont
- Function : Author
- PersonId : 913042
- ORCID : 0000-0002-5644-3412
- IdRef : 089058127
Beny Charbit
- Function : Author
Arthur Davy
- Function : Author
David Lobo
- Function : Author
Jean-Michel Devys
- Function : Author
Benjamin Soria
- Function : Author
Clémentine Cholet
- Function : Author
Cyrus Motamed
- Function : Author
Anne Wyniecki
- Function : Author
Valérie Billard
- Function : Author
Migena Demiri
- Function : Author
Clement Millet
- Function : Author
Samuel Degoul
- Function : Author
Christophe Canevet
- Function : Author
Céline Mounier
- Function : Author
Flavie Desrumaux
- Function : Author
Julia Martinez
- Function : Author
Claire Texier
- Function : Author
Benoit Voisin
- Function : Author
Guillaume Dubreuil
- Function : Author
Jacques de Montblanc
- Function : Author
Claire Mengelle
- Function : Author
Laura Ruscio
- Function : Author
Emmanuel Futier
- Function : Author
Julie Fayon
- Function : Author
Benoit Baietto
- Function : Author
Marie Vignaud
- Function : Author
Yoann Munier
- Function : Author
Bertille Paquette
- Function : Author
Diana Saptefrat
- Function : Author
Zakia Machroub
- Function : Author
Jean-Sébastien Aubert
- Function : Author
Georges Abi Abdallah
- Function : Author
Nicolas Polge
- Function : Author
Najla Dachraoui
- Function : Author
Anne Godier
- Function : Author
Diane Zlotnik
- Function : Author
Hélène Nougue
- Function : Author
Darless Clausse
- Function : Author
Sabrina Ma
- Function : Author
Sherifatou Salami-Adjavon
- Function : Author
Patrick Rossignol
- Function : Author
Francis Berthier
- Function : Author
Romain Barthélémy
- Function : Author
Gabriel Vianet
- Function : Author
Damien Logeart
- Function : Author
Peggy Reiner
- Function : Author
Karine Pautrat
- Function : Author
Alex Hong
- Function : Author
Marine Coroir
- Function : Author
Claire Mayeur
- Function : Author
Jacques Thes
- Function : Author
Florent Laverdure
- Function : Author
Sofiane Seri
- Function : Author
Violeta Bercan
- Function : Author
Cristian Radu Ionescu
- Function : Author
Caroline Gonnet Pinton
- Function : Author
Marc Leone
- Function : Author
Nathalie Lesavre
- Function : Author
Jeanne Chatelon
- Function : Author
Marion Poirier
- Function : Author
Adrien Rivory
- Function : Author
Stéphanie Roullet
- Function : Author
Sean Coeckelenbergh
- Function : Author
Leila Toubal
- Function : Author
Joanna Ramadan
- Function : Author
Karine Nouette-Gaulain
- Function : Author
Benoît Tavernier
- Function : Author
Julie Bellet
- Function : Author
Romain Delassus
- Function : Author
Hélène Tribouillard
- Function : Author
Daniel Verzilli
- Function : Author
Alice Millot
- Function : Author
Marie Geniez
- Function : Author
Virginie Marre
- Function : Author
Michaëla Penne
- Function : Author
Yvan Pouzeratte
- Function : Author
Guillaume Rao
- Function : Author
Maxime Coutrot
- Function : Author
Alice Blet
- Function : Author
Benoit Plaud
- Function : Author
Emmanuel Basto
- Function : Author
Mathilde Ponsin
- Function : Author
Marie-Christine Becq
- Function : Author
Maïté Chaussard
- Function : Author
Aristide Ntahe
- Function : Author
François Depret
- Function : Author
Lucie Guillemet
- Function : Author
Arnaud Valent
- Function : Author
Lyse Flores
- Function : Author
Julien Burey
- Function : Author
Sarah Feray
- Function : Author
Yoann Elmaleh
- Function : Author
Sophie Dupeyrat
- Function : Author
Thomas Baury
- Function : Author
Clémentine Taconet
- Function : Author
Thomas Rimmele
- Function : Author
Elodie Mazocky
- Function : Author
Marie Luce Parrouffe
- Function : Author
Catherine Jadaud
- Function : Author
Stanislas Abrard
- Function : Author
Pierre-Antoine Tronche
- Function : Author
Arthur Vial
- Function : Author
Emma Aka
- Function : Author
Anne-Sophie Bellocq
- Function : Author
Jean-François Carabalona
- Function : Author
Blandine Fayard
- Function : Author
Jean Marie Guyader
- Function : Author
Letitia Huriaux
- Function : Author
Ingrid Millot
- Function : Author
Antoine Lamblin
- Function : Author
Marine Dutour
- Function : Author
Mathilde Roukhomovsky-Moretti
- Function : Author
Pascal Meuret
- Function : Author
Nadir Omrani
- Function : Author
Barnabé Raymond
- Function : Author
Clemence Roy
- Function : Author
Florent Sigwalt
- Function : Author
Xavier Merindol
- Function : Author
Mathieu Desmard
- Function : Author
Louis Bourreau
- Function : Author
Pierre-Antoine Allain
- Function : Author
Charlotte Dei Svaldi
- Function : Author
Brenton Alexander
- Function : Author
Abstract
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 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. Trial Registration ClinicalTrials.gov Identifier: NCT03374449