title: Impact of prophylactic beta-blocker therapy to prevent stroke after noncardiac surgery.
abstract: beta Blockers are widely used to improve the postoperative cardiac outcome in patients with coronary artery disease scheduled for noncardiac surgery. However, recently serious concerns regarding the safety of perioperative beta blockers have emerged. To assess the incidence, risk factors, and beta-blocker use associated with postoperative stroke in the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography (DECREASE) trials, we evaluated all 3,884 patients of the DECREASE trials for postoperative stroke. All cardiac risk factors and medication use were assessed. The incidence of stroke within 30 days after surgery was recorded. The incidence of postoperative stroke in the DECREASE trials was 0.46% (18 of 3,884). For the beta-blocker users, the incidence was 0.5%. All the strokes had an ischemic origin. A history of stroke was associated with a greater incidence of postoperative stroke (odds ratio [OR] 3.79, 95% confidence interval [CI] 1.2 to 11.6). Statins and anticoagulants were not associated with postoperative stroke (OR 0.85, 95% CI 0.3 to 2.4; and OR 1.27, 95% CI 0.4 to 4.6, respectively). No association with bisoprolol therapy was found (OR 1.16, 95% CI 0.4 to 3.4). In conclusion, with a low-dose bisoprolol regimen started > or =30 days before surgery, no association was observed between beta-blocker use and postoperative stroke.
authors.affiliation: Department of Anesthesiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Felix
authors.initials: F
authors.lastname: van Lier
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Louis
authors.initials: L
authors.lastname: van de Ven
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Stolker
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D017298:Bisoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D017298:Bisoprolol