Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial

doi:10.1001/jama.2024.17123

Randomized Controlled Trial

. 2024 Sep 24;332(12):970-978.

doi: 10.1001/jama.2024.17123.

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial

Matthieu Legrand^{1

2}, Jérémy Falcone³, Bernard Cholley⁴, Hélène Charbonneau⁵, Amélie Delaporte⁶, Adrien Lemoine⁷, Matthias Garot³, Alexandre Joosten⁸, Claude Meistelman⁹, Delphine Cheron-Leroy¹⁰, Jean-Philippe Rives¹¹, Bruno Pastene¹², Antoine Dewitte^{13

14}, Stéphanie Sigaut¹⁵, Marc Danguy des Deserts¹⁶, Cyrille Truc¹⁷, Matthieu Boisson¹⁸, Sigismond Lasocki¹⁹, Philippe Cuvillon²⁰, Ugo Schiff²¹, Samir Jaber²², Morgan Le Guen²³, Anaïs Caillard²⁴, Stéphane Bar²⁵, Edmundo Pereira de Souza Neto²⁶, Vincent Colas²⁷, Florin Dimache²⁸, Thibaut Girardot²⁹, Elsa Jozefowicz³⁰, Simon Viquesnel³¹, Francis Berthier³², Eric Vicaut³³, Etienne Gayat^{2

34

35}; Stop-or-Not Trial Group

Collaborators, Affiliations

Collaborators

Stop-or-Not Trial Group:
Simon Monziols, Mylene Defaye, Thibault Camus, Jean-Jacques Robin, Alexandre Ouattara, Ioana Fetita, Olivier Joannes-Boyau, Eline Bonnardel, Rémi Bouquerel, Antoine Strzelecki, Thibaut Fayon, Christophe Pelletier, Benjamin LE Gaillard, Thibaut Girardot, Géraud Amoussou, Maalik El Bouyousfi, Bruno Ganascia, Calliope Butrulle, Soizic Gergaud, Pierre Habrial, Solène Pessiot, Emmanuel Samson, Caroline Wolff, Nevena Stankova, Farida Aouati, Juliette Kavafyan, Vlad Suparschi, Dan Longrois, Julie LE Roy, Benoit Rossignol, Olivier Huet, Christophe Boisson, Pierre Olivier Bonnin, Mohamed Dhaouadi, Ghislaine Gardes, Mikael Perin, Sophie Brunet, Yann Gricourt, Marc-Olivier Fischer, Stéphane Debroczi, Lucie Retournay, Pierre Strub, Patrice Vivin, Rachel Dupays, Thomas Kerforne, Gabriel Vianet, Virginie Manzano, Eric Noll, Pierre-Olivier Ludes, Thien-Nga Chamaraux-Tran, Cédric Cirenei, Djihad Hamroun, Benoit Lebas, Grégoire Andrieu Andrieu, Vincent Etienne, Raphaël Cinotti, Natacha Simon, Denis Frasca, Hélène Beloeil, Amandine LE Gall, Petyo Techev, Ludovic Meuret, Jérémie Joffre, Hervé Dupont, Beny Charbit, Arthur Davy, David Lobo, Jean-Michel Devys, Benjamin Soria, Clémentine Cholet, Cyrus Motamed, Anne Wyniecki, Valérie Billard, Migena Demiri, Clement Millet, Samuel Degoul, Christophe Canevet, Céline Mounier, Flavie Desrumaux, Julia Martinez, Claire Texier, Benoit Voisin, Guillaume Dubreuil, Jacques DE Montblanc, Claire Mengelle, Laura Ruscio, Emmanuel Futier, Julie Fayon, Benoit Baietto, Marie Vignaud, Yoann Munier, Bertille Paquette, Diana Saptefrat, Zakia Machroub, Jean-Sébastien Aubert, Georges Abi Abdallah, Nicolas Polge, Najla Dachraoui, Anne Godier, Diane Zlotnik, Hélène Nougue, Darless Clausse, Sabrina Ma, Sherifatou Salami-Adjavon, Patrick Rossignol, Francis Berthier, Romain Barthélémy, Gabriel Vianet, Damien Logeart, Peggy Reiner, Karine Pautrat, Alex Hong, Marine Coroir, Claire Mayeur, Jacques Thes, Florent Laverdure, Sofiane Seri, Violeta Bercan, Cristian Radu Ionescu, Caroline Gonnet Pinton, Marc Leone, Nathalie Lesavre, Jeanne Chatelon, Marion Poirier, Adrien Rivory, Stéphanie Roullet, Sean Coeckelenbergh, Leila Toubal, Joanna Ramadan, Karine Nouette-Gaulain, Bruno Ralec, Chloé Thill, Christophe Giacardi, Etienne Montelescaut, Philippe Aries, Benoît Tavernier, Julie Bellet, Romain Delassus, Hélène Tribouillard, Daniel Verzilli, Alice Millot, Audrey DE Jong, Marie Geniez, Virginie Marre, Michaëla Penne, Yvan Pouzeratte, Guillaume Rao, Maxime Coutrot, Alice Blet, Benoit Plaud, Emmanuel Basto, Mathilde Ponsin, Marie-Christine Becq, Maïté Chaussard, Aristide Ntahe, François Depret, Lucie Guillemet, Arnaud Valent, Lyse Flores, Julien Burey, Sarah Feray, Yoann Elmaleh, Sophie Dupeyrat, Thomas Baury, Clémentine Taconet, Thomas Rimmele, Elodie Mazocky, Marie Luce Parrouffe, Catherine Jadaud, Stanislas Abrard, Pierre-Antoine Tronche, Arthur Vial, Emma Aka, Anne-Sophie Bellocq, Jean-François Carabalona, Blandine Fayard, Jean Marie Guyader, Letitia Huriaux, Ingrid Millot, Antoine Lamblin, Marine Dutour, Mathilde Roukhomovsky-Moretti, Pascal Meuret, Nadir Omrani, Barnabé Raymond, Clemence Roy, Florent Sigwalt, Xavier Merindol, Mathieu Desmard, Louis Bourreau, Pierre-Antoine Allain, Charlotte Dei Svaldi, Brenton Alexander

Affiliations

¹ Department of Anesthesiology and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco.
² French Clinical Research Infrastructure Network Initiative-Cardio Renal Clinical Trialists Network, Nancy, France.
³ Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Lille, France.
⁴ Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
⁵ Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, Toulouse, France.
⁶ Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
⁷ Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Tenon, APHP, Sorbonne Université, Paris, France.
⁸ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles.
⁹ Department of Anesthesiology, CHU de Nancy Brabois and Hopital Saint Charles, Saint Dié des Vosges, France.
¹⁰ Université Paris Cité, AP-HP, Hôpital Saint-Louis, DMU PARABOL, Service d'Anesthésie-Réanimation-Centre de Traitment des Brûlés, Paris, France.
¹¹ Service d'Anesthésie, Département d'Anesthésie, de Chirurgie et Interventionnel, Hôpital Gustave Roussy, Villejuif, France.
¹² Aix Marseille Université, APHM, Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France.
¹³ Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
¹⁴ Université de Bordeaux, CNRS, Inserm, Immuno ConcEpT, UMR 5164, Bordeaux, France.
¹⁵ Department of Anesthesiology and Intensive Care, AP-HP, Hôpital Beaujon, Clichy, France.
¹⁶ Department of Anesthesia and Intensive Care, Clermont-Tonnerre Military Hospital, Univ Brest, Inserm, UMR 1304-GETBO, Brest, France.
¹⁷ Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
¹⁸ Université de Poitiers, INSERM U1070 PHAR2, CHU de Poitiers, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Poitiers, France.
¹⁹ Département Anesthésie Réanimation, CHU d'Angers, Angers, France.
²⁰ Département Anesthésie, Centre Hospitalier Universitaire Caremeau, Nîmes et Université Montpellier 1, Montpellier, France.
²¹ Centre Hospitalier Universitaire de Clermont Ferrand, Hôpital Estaing, Clermont Ferrand, France.
²² Anesthesia and Critical Care Department, Saint Eloi, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, Montpellier, France.
²³ Hôpital Foch, Suresnes, France.
²⁴ Département Anesthésie Réanimation, Centre Hospitalier Universitaire Brest, Brest, France.
²⁵ Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Rond-Point du Professeur Christian Cabrol, Amiens, France.
²⁶ Centre Hospitalier de Montauban, Montauban, France.
²⁷ Hôpital Saint Philibert-Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.
²⁸ Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
²⁹ Centre Hospitalier de Valence, Valence, France.
³⁰ Departement d'Anesthesie-Reanimation, Centre Hospitalier Universitaire de Lille, Hôpital Roger Salengro, Lille, France.
³¹ Anesthesia and Intensive Care Department, Université de Rennes, CHU Rennes, Rennes, France.
³² Département d'Anesthésie Réanimation Chirurgicale, Université de Franche-Comté, Centre Hospitalier Universitaire Besançon, INSERM CIC 1431, SINERGIES, Besançon, France.
³³ Unité de Recherche Clinique, GH St-Louis-Lariboisère-Fernand Widal, Université Paris Diderot, Paris, France.
³⁴ Université Paris Cité, AP-HP, Hôpital Lariboisière, DMU PARABOL, Service d'Anesthésie-Réanimation-CTB, Paris, France.
³⁵ Inserm U942 MASCOT, Paris, France.

PMID: 39212270
PMCID: PMC11365013 (available on 2025-03-02)
DOI: 10.1001/jama.2024.17123

Randomized Controlled Trial

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial

Matthieu Legrand et al. JAMA. 2024.

. 2024 Sep 24;332(12):970-978.

doi: 10.1001/jama.2024.17123.

Authors

Collaborators

Stop-or-Not Trial Group:
Simon Monziols, Mylene Defaye, Thibault Camus, Jean-Jacques Robin, Alexandre Ouattara, Ioana Fetita, Olivier Joannes-Boyau, Eline Bonnardel, Rémi Bouquerel, Antoine Strzelecki, Thibaut Fayon, Christophe Pelletier, Benjamin LE Gaillard, Thibaut Girardot, Géraud Amoussou, Maalik El Bouyousfi, Bruno Ganascia, Calliope Butrulle, Soizic Gergaud, Pierre Habrial, Solène Pessiot, Emmanuel Samson, Caroline Wolff, Nevena Stankova, Farida Aouati, Juliette Kavafyan, Vlad Suparschi, Dan Longrois, Julie LE Roy, Benoit Rossignol, Olivier Huet, Christophe Boisson, Pierre Olivier Bonnin, Mohamed Dhaouadi, Ghislaine Gardes, Mikael Perin, Sophie Brunet, Yann Gricourt, Marc-Olivier Fischer, Stéphane Debroczi, Lucie Retournay, Pierre Strub, Patrice Vivin, Rachel Dupays, Thomas Kerforne, Gabriel Vianet, Virginie Manzano, Eric Noll, Pierre-Olivier Ludes, Thien-Nga Chamaraux-Tran, Cédric Cirenei, Djihad Hamroun, Benoit Lebas, Grégoire Andrieu Andrieu, Vincent Etienne, Raphaël Cinotti, Natacha Simon, Denis Frasca, Hélène Beloeil, Amandine LE Gall, Petyo Techev, Ludovic Meuret, Jérémie Joffre, Hervé Dupont, Beny Charbit, Arthur Davy, David Lobo, Jean-Michel Devys, Benjamin Soria, Clémentine Cholet, Cyrus Motamed, Anne Wyniecki, Valérie Billard, Migena Demiri, Clement Millet, Samuel Degoul, Christophe Canevet, Céline Mounier, Flavie Desrumaux, Julia Martinez, Claire Texier, Benoit Voisin, Guillaume Dubreuil, Jacques DE Montblanc, Claire Mengelle, Laura Ruscio, Emmanuel Futier, Julie Fayon, Benoit Baietto, Marie Vignaud, Yoann Munier, Bertille Paquette, Diana Saptefrat, Zakia Machroub, Jean-Sébastien Aubert, Georges Abi Abdallah, Nicolas Polge, Najla Dachraoui, Anne Godier, Diane Zlotnik, Hélène Nougue, Darless Clausse, Sabrina Ma, Sherifatou Salami-Adjavon, Patrick Rossignol, Francis Berthier, Romain Barthélémy, Gabriel Vianet, Damien Logeart, Peggy Reiner, Karine Pautrat, Alex Hong, Marine Coroir, Claire Mayeur, Jacques Thes, Florent Laverdure, Sofiane Seri, Violeta Bercan, Cristian Radu Ionescu, Caroline Gonnet Pinton, Marc Leone, Nathalie Lesavre, Jeanne Chatelon, Marion Poirier, Adrien Rivory, Stéphanie Roullet, Sean Coeckelenbergh, Leila Toubal, Joanna Ramadan, Karine Nouette-Gaulain, Bruno Ralec, Chloé Thill, Christophe Giacardi, Etienne Montelescaut, Philippe Aries, Benoît Tavernier, Julie Bellet, Romain Delassus, Hélène Tribouillard, Daniel Verzilli, Alice Millot, Audrey DE Jong, Marie Geniez, Virginie Marre, Michaëla Penne, Yvan Pouzeratte, Guillaume Rao, Maxime Coutrot, Alice Blet, Benoit Plaud, Emmanuel Basto, Mathilde Ponsin, Marie-Christine Becq, Maïté Chaussard, Aristide Ntahe, François Depret, Lucie Guillemet, Arnaud Valent, Lyse Flores, Julien Burey, Sarah Feray, Yoann Elmaleh, Sophie Dupeyrat, Thomas Baury, Clémentine Taconet, Thomas Rimmele, Elodie Mazocky, Marie Luce Parrouffe, Catherine Jadaud, Stanislas Abrard, Pierre-Antoine Tronche, Arthur Vial, Emma Aka, Anne-Sophie Bellocq, Jean-François Carabalona, Blandine Fayard, Jean Marie Guyader, Letitia Huriaux, Ingrid Millot, Antoine Lamblin, Marine Dutour, Mathilde Roukhomovsky-Moretti, Pascal Meuret, Nadir Omrani, Barnabé Raymond, Clemence Roy, Florent Sigwalt, Xavier Merindol, Mathieu Desmard, Louis Bourreau, Pierre-Antoine Allain, Charlotte Dei Svaldi, Brenton Alexander

Affiliations

¹ Department of Anesthesiology and Perioperative Care, Division of Critical Care Medicine, University of California, San Francisco.
² French Clinical Research Infrastructure Network Initiative-Cardio Renal Clinical Trialists Network, Nancy, France.
³ Centre Hospitalier Universitaire de Lille, Hôpital Huriez, Lille, France.
⁴ Department of Anesthesiology and Intensive Care, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.
⁵ Department of Anesthesiology and Intensive Care Unit, Clinique Pasteur, Toulouse, France.
⁶ Hôpital Marie Lannelongue, Le Plessis-Robinson, France.
⁷ Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital Tenon, APHP, Sorbonne Université, Paris, France.
⁸ Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles.
⁹ Department of Anesthesiology, CHU de Nancy Brabois and Hopital Saint Charles, Saint Dié des Vosges, France.
¹⁰ Université Paris Cité, AP-HP, Hôpital Saint-Louis, DMU PARABOL, Service d'Anesthésie-Réanimation-Centre de Traitment des Brûlés, Paris, France.
¹¹ Service d'Anesthésie, Département d'Anesthésie, de Chirurgie et Interventionnel, Hôpital Gustave Roussy, Villejuif, France.
¹² Aix Marseille Université, APHM, Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France.
¹³ Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire de Bordeaux, Pessac, France.
¹⁴ Université de Bordeaux, CNRS, Inserm, Immuno ConcEpT, UMR 5164, Bordeaux, France.
¹⁵ Department of Anesthesiology and Intensive Care, AP-HP, Hôpital Beaujon, Clichy, France.
¹⁶ Department of Anesthesia and Intensive Care, Clermont-Tonnerre Military Hospital, Univ Brest, Inserm, UMR 1304-GETBO, Brest, France.
¹⁷ Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
¹⁸ Université de Poitiers, INSERM U1070 PHAR2, CHU de Poitiers, Service d'Anesthésie-Réanimation et Médecine Péri-Opératoire, Poitiers, France.
¹⁹ Département Anesthésie Réanimation, CHU d'Angers, Angers, France.
²⁰ Département Anesthésie, Centre Hospitalier Universitaire Caremeau, Nîmes et Université Montpellier 1, Montpellier, France.
²¹ Centre Hospitalier Universitaire de Clermont Ferrand, Hôpital Estaing, Clermont Ferrand, France.
²² Anesthesia and Critical Care Department, Saint Eloi, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, Montpellier, France.
²³ Hôpital Foch, Suresnes, France.
²⁴ Département Anesthésie Réanimation, Centre Hospitalier Universitaire Brest, Brest, France.
²⁵ Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Rond-Point du Professeur Christian Cabrol, Amiens, France.
²⁶ Centre Hospitalier de Montauban, Montauban, France.
²⁷ Hôpital Saint Philibert-Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille, France.
²⁸ Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.
²⁹ Centre Hospitalier de Valence, Valence, France.
³⁰ Departement d'Anesthesie-Reanimation, Centre Hospitalier Universitaire de Lille, Hôpital Roger Salengro, Lille, France.
³¹ Anesthesia and Intensive Care Department, Université de Rennes, CHU Rennes, Rennes, France.
³² Département d'Anesthésie Réanimation Chirurgicale, Université de Franche-Comté, Centre Hospitalier Universitaire Besançon, INSERM CIC 1431, SINERGIES, Besançon, France.
³³ Unité de Recherche Clinique, GH St-Louis-Lariboisère-Fernand Widal, Université Paris Diderot, Paris, France.
³⁴ Université Paris Cité, AP-HP, Hôpital Lariboisière, DMU PARABOL, Service d'Anesthésie-Réanimation-CTB, Paris, France.
³⁵ Inserm U942 MASCOT, Paris, France.

PMID: 39212270
PMCID: PMC11365013 (available on 2025-03-02)
DOI: 10.1001/jama.2024.17123

Abstract

Importance: Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.

Objective: To evaluate whether a continuation strategy vs a discontinuation strategy of RASIs before major noncardiac surgery results in decreased complications at 28 days after surgery.

Design, setting, and participants: Randomized clinical trial that included patients who were being treated with a RASI for at least 3 months and were scheduled to undergo a major noncardiac surgery between January 2018 and April 2023 at 40 hospitals in France.

Intervention: Patients were randomized to continue use of RASIs (n = 1107) until the day of surgery or to discontinue use of RASIs 48 hours prior to surgery (ie, they would take the last dose 3 days before surgery) (n = 1115).

Main outcomes and measures: The primary outcome was a composite of all-cause mortality and major postoperative complications within 28 days after surgery. The key secondary outcomes were episodes of hypotension during surgery, acute kidney injury, postoperative organ failure, and length of stay in the hospital and intensive care unit during the 28 days after surgery.

Results: Of the 2222 patients (mean age, 67 years [SD, 10 years]; 65% were male), 46% were being treated with angiotensin-converting enzyme inhibitors at baseline and 54% were being treated with angiotensin receptor blockers. The rate of all-cause mortality and major postoperative complications was 22% (245 of 1115 patients) in the RASI discontinuation group and 22% (247 of 1107 patients) in the RASI continuation group (risk ratio, 1.02 [95% CI, 0.87-1.19]; P = .85). Episodes of hypotension during surgery occurred in 41% of the patients in the RASI discontinuation group and in 54% of the patients in the RASI continuation group (risk ratio, 1.31 [95% CI, 1.19-1.44]). There were no other differences in the trial outcomes.

Conclusions and relevance: Among patients who underwent major noncardiac surgery, a continuation strategy of RASIs before surgery was not associated with a higher rate of postoperative complications than a discontinuation strategy.

Trial registration: ClinicalTrials.gov Identifier: NCT03374449.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Legrand reported receiving grants from the National Institutes of Health and receiving personal fees from Viatris, Alexion, La Jolla, Pharmazz Inc, and Radiometer. Dr Pastene reported receiving personal fees from Edwards Lifesciences. Dr Sigaut reported receiving personal fees from the French Directorate General of Health Care Provision. Dr Boisson reported receiving personal fees from Becton Dickinson and Edwards Lifesciences. Dr Lasocki reported receiving personal fees from Vifor Pharma, Pharmacosmos, Masimo, and Pfizer. Dr Jaber reported receiving personal fees from Fisher Paykel, Drager, Mindray, Baxter, and Medtronic. Dr Le Guen reported receiving personal fees from General Electric and Fisher & Paykel and receiving nonfinancial support from Medtronic. Dr Vicaut reported receiving personal fees from Abbott and Coloplast. Dr Gayat reported receiving personal fees from General Electric and Mindray. No other disclosures were reported.

Cited by

[Cardiovascular management of patients undergoing noncardiac surgery].
Schirmer SH. Schirmer SH. Herz. 2024 Dec;49(6):479-488. doi: 10.1007/s00059-024-05274-x. Epub 2024 Oct 21. Herz. 2024. PMID: 39432064 Review. German.

References

1. Hollmann C, Fernandes NL, Biccard BM. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg. 2018;127(3):678-687. doi:10.1213/ANE.0000000000002837 - DOI - PubMed
1. Roshanov PS, Rochwerg B, Patel A, et al. . Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery: an analysis of the vascular events in noncardiac surgery patients cohort evaluation prospective cohort. Anesthesiology. 2017;126(1):16-27. doi:10.1097/ALN.0000000000001404 - DOI - PubMed
1. Mets B. To stop or not? Anesth Analg. 2015;120(6):1413-1419. doi:10.1213/ANE.0000000000000758 - DOI - PubMed
1. Kristensen SD, Knuuti J, Saraste A, et al. ; Authors/Task Force Members . 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383-2431. doi:10.1093/eurheartj/ehu282 - DOI - PubMed
1. Fleisher LA, Fleischmann KE, Auerbach AD, et al. . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;130(24):e278-e333. doi:10.1161/CIR.0000000000000106 - DOI - PubMed

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[1] Hollmann C, Fernandes NL, Biccard BM. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg. 2018;127(3):678-687. doi:10.1213/ANE.0000000000002837 - DOI - PubMed

[2] Hollmann C, Fernandes NL, Biccard BM. A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery. Anesth Analg. 2018;127(3):678-687. doi:10.1213/ANE.0000000000002837 - DOI - PubMed

[3] Roshanov PS, Rochwerg B, Patel A, et al. . Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery: an analysis of the vascular events in noncardiac surgery patients cohort evaluation prospective cohort. Anesthesiology. 2017;126(1):16-27. doi:10.1097/ALN.0000000000001404 - DOI - PubMed

[4] Roshanov PS, Rochwerg B, Patel A, et al. . Withholding versus continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers before noncardiac surgery: an analysis of the vascular events in noncardiac surgery patients cohort evaluation prospective cohort. Anesthesiology. 2017;126(1):16-27. doi:10.1097/ALN.0000000000001404 - DOI - PubMed

[5] Mets B. To stop or not? Anesth Analg. 2015;120(6):1413-1419. doi:10.1213/ANE.0000000000000758 - DOI - PubMed

[6] Mets B. To stop or not? Anesth Analg. 2015;120(6):1413-1419. doi:10.1213/ANE.0000000000000758 - DOI - PubMed

[7] Kristensen SD, Knuuti J, Saraste A, et al. ; Authors/Task Force Members . 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383-2431. doi:10.1093/eurheartj/ehu282 - DOI - PubMed

[8] Kristensen SD, Knuuti J, Saraste A, et al. ; Authors/Task Force Members . 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35(35):2383-2431. doi:10.1093/eurheartj/ehu282 - DOI - PubMed

[9] Fleisher LA, Fleischmann KE, Auerbach AD, et al. . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;130(24):e278-e333. doi:10.1161/CIR.0000000000000106 - DOI - PubMed

[10] Fleisher LA, Fleischmann KE, Auerbach AD, et al. . 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;130(24):e278-e333. doi:10.1161/CIR.0000000000000106 - DOI - PubMed

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Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial

Collaborators

Affiliations

Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery: The Stop-or-Not Randomized Clinical Trial

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

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Cited by

References

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