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Metoprolol around the time of surgery increases the risk of death and stroke: POISE trial
Date:5/12/2008

Hamilton, ON (May 12, 2008) - Beta-blocker drugs may help prevent heart attacks during surgery, but they may increase the risk of death and major stroke, says a major study to be published online today by the prestigious medical journal, The Lancet.

POISE is the worlds largest randomized trial addressing perioperative cardiac complications. POISE evaluated the effects of a beta-blocker versus placebo given to patients around the time of surgery.

POISE demonstrates that a beta-blocker given around the time of surgery decreases a patients risk of a heart attack but increases their risk of a major stroke and death, said Dr. P.J. Devereaux, POISE co-principle investigator, McMaster University, Hamilton, Canada.

Worldwide approximately 100 million adults have major non-cardiac surgery (i.e., all surgeries excluding heart surgeries) each year. Among them, more than one million will suffer a major heart complication such as a heart attack or death.

Surgery increases patients catecholamines, or stress hormones, which increase the hearts requirement for oxygen. The stress on the heart can lead to serious events like a heart attack. Because beta-blockers reduce the effects of increased catecholamines some physicians believed they may prevent serious heart complications around the time of surgery.

Initial small trials suggested beta-blockers were beneficial around the time of surgery but more recent moderate sized trials did not show any benefit, Dr. Homer Yang, POISE co-principal investigator, University of Ottawa, Ottawa, Canada. We undertook POISE to provide a clearer understanding of the effects of a beta-blocker around the time of surgery.

A major accomplishment of POISE was that anesthesiologists, cardiologists, internists, and surgeons at 190 centres in 23 countries came together and randomized 8,351 patients - more than 4 times as many patients than all the previous perioperative beta-blocker trial
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Contact: Veronica McGuire
vmcguir@mcmaster.ca
90-552-591-402-2169
McMaster University
Source:Eurekalert

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