Metoprolol around the time of surgery increases the risk of death and stroke: P...(s combined. Such efforts are rare but e...),Health

The POISE Trial randomized 4,174 patients to receive extended-release metoprolol succinate and 4,177 patients to receive placebo starting two to four hours before surgery and continuing for 30 days after surgery.

Fewer patients in the metoprolol group (176) than in the placebo group (239) suffered a heart attack, indicating that patients receiving metoprolol were 27 percent less likely to suffer a heart attack. However, 129 metoprolol patients compared to 97 placebo patients died, indicating that patients receiving metoprolol were 33 percent more likely to die. Further, 41 metoprolol patients versus 19 placebo patients suffered a stroke, indicating that patients receiving metoprolol had more than double the risk of a stroke.

Considering the heart attacks less than one-third of these patients also had a complication of their heart attack like heart failure. In contrast more than half of the patients who suffered a stroke were left incapacitated or needing help with everyday activities.

The POISE results suggest for every 1,000 patients with a similar risk profile who have noncardiac surgery, metoprolol will prevent 15 patients from having a heart attack, three from having angioplasty or coronary artery bypass surgery, and seven from developing new atrial fibrillation (a heart rhythm disorder).

The results also suggest that for every 1,000 patients, metoprolol would cause eight patients to die, five patients to have a stroke, 53 patients to experience a low blood pressure that would require treatment, and 42 patients to experience a low heart rate that would require treatment. Analysis of the POISE data suggests that metoprolol increased the risk of death and stroke by increasing the risk of the low blood pr
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