Perioperatieve ß-blokkade voor reductie van cardiale complicaties bij niet-cardiale operaties: voordelen, maar ook nadelen

- The results of the recently published PeriOperative ISchemic Evaluation (POISE) trial show that perioperative use of metoprolol in patients with atherosclerosis undergoing major non-cardiac surgery reduces the risk of cardiovascular complications. This effect was primarily produced by a 1.5 reduction in non-fatal myocardial infarction (MI), but this advantage was outweighed by a 0.8 increase in total mortality and a 0.5 increase in non-fatal stroke. These results, combined with previous meta-analyses, confirm that non-fatal MI is reduced at the cost of a statistically significant increase in stroke rate and a near significant increase in mortality. It is likely that the increase in complications is due to a high dose of metoprolol being given too shortly before the operation. These findings call for judicious perioperative use of adrenergic β-antagonists in cardiac-high-risk patients undergoing high risk non-cardiac surgery. Dosage should be lower and administration should be implemented longer before the operation.

Ned Tijdschr Geneeskd. 2008;152:2603-5