These follow-up findings confirm that an increased risk for death or a stroke persists at one year post-surgery in patients treated with metoprolol, said P.J. Devereaux, MD, PhD, director of cardiology at McMaster University in Hamilton, Canada, and lead author of the study. Previously reported results from the same study at 30 days post-surgery showed a similar pattern, with a reduction in heart attacks but increases in deaths and strokes.
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"Our results suggest at one year, for every 1,000 patients having noncardiac surgery, treatment with metoprolol would prevent heart attacks in 12 patients but would result in an excess of 13 deaths and six strokes," Devereaux said.
"While there is little doubt that some patients benefit from receiving beta blockers during the period immediately before and after noncardiac surgery, these data show that at least as many patients are seriously harmed," he said. "These data tell us that we need to exercise caution when using beta blockers in this setting until we figure out how to mitigate the substantial risks and enable all patients to obtain the potential benefits of this intervention."
"Our results suggest at one year, for every 1,000 patients having noncardiac surgery, treatment with metoprolol would prevent heart attacks in 12 patients but would result in an excess of 13 deaths and six strokes," Devereaux said.
"While there is little doubt that some patients benefit from receiving beta blockers during the period immediately before and after noncardiac surgery, these data show that at least as many patients are seriously harmed," he said. "These data tell us that we need to exercise caution when using beta blockers in this setting until we figure out how to mitigate the substantial risks and enable all patients to obtain the potential benefits of this intervention."
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Beta blockers work by slowing the heart rate and relaxing the blood vessels, which in turn reduces blood pressure. The problem, Devereaux said, is that during the period immediately after major noncardiac surgery (such as a hip or knee replacement, bowel resection or abdominal aortic aneurysm repair), patients are usually treated with opioid medications to relieve pain. The effects of those medications may mask drops in blood pressure or heart rate to dangerously low levels.
Beta blockers work by slowing the heart rate and relaxing the blood vessels, which in turn reduces blood pressure. The problem, Devereaux said, is that during the period immediately after major noncardiac surgery (such as a hip or knee replacement, bowel resection or abdominal aortic aneurysm repair), patients are usually treated with opioid medications to relieve pain. The effects of those medications may mask drops in blood pressure or heart rate to dangerously low levels.
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"Low blood pressure, or hypotension, is common in this setting and is a main contributor to the adverse effects resulting from perioperative beta blockers," he said.
Patients who become hypotensive for whatever reason after surgery (e.g., sepsis, bleeding, heart failure) find their problem exacerbated when they are receiving a beta blocker, which further lowers blood pressure and makes treating hypotension more challenging.
"Low blood pressure, or hypotension, is common in this setting and is a main contributor to the adverse effects resulting from perioperative beta blockers," he said.
Patients who become hypotensive for whatever reason after surgery (e.g., sepsis, bleeding, heart failure) find their problem exacerbated when they are receiving a beta blocker, which further lowers blood pressure and makes treating hypotension more challenging.
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