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49 results on '"Paniagua, Pilar"'

1. Temporal Trends in the Management Practices of Clinically Important Perioperative Atrial Fibrillation After Noncardiac Surgery

Author

Wang, Michael Ke, Devereaux, P.J., Marcucci, Maura, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Ofori, Sandra N., Paniagua, Pilar, Douketis, James D., Sigamani, Alben, Parlow, Joel L., Wang, Chew Y., Villar, Juan Carlos, Srinathan, Sadeesh K., Szczeklik, Wojciech, Martínez-Zapata, María José, Malaga, German, Sivakumaran, Soori, McIntyre, William F., Rodríguez Funes, María-Virginia, Cruz, Patricia, Alvarez-Garcia, Jesús, Greiss, Isabelle, Popova, Ekaterine, Hemels, Martin E., Brandes, Axel, Chow, Clara K., Barnawal, Satish Prasad, Healey, Jeff S., and Conen, David

Published
2024
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2. A sub-study of the POISE-3 randomized trial examined effects of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy on the risk of acute kidney injury

Author

Garg, Amit X., Marcucci, Maura, Cuerden, Meaghan S., Sontrop, Jessica M., Painter, Thomas W., Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Leslie, Kate, Duceppe, Emmanuelle, Parikh, Chirag R., Roshanov, Pavel, Martínez-Zapata, María José, Wang, Chew Yin, Xavier, Denis, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Meyhoff, Christian S., Short, Timothy G., Amir, Mohammed, Torres, David, Wittmann, Maria, Patel, Ameen, Ruetzler, Kurt, Parlow, Joel L., Jayaram, Raja, Polanczyk, Carisi A., Fleischmann, Edith, Tandon, Vikas, Astrakov, Sergey V., Conen, David, Kei Wu, William Ka, Cheong, Chao Chia, Ayad, Sabry, Kirov, Mikhail, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Ofori, Sandra N., Vincent, Jessica, Copland, Ingrid, Balasubramanian, Kumar, Biccard, Bruce M., Srinathan, Sadeesh, Ismoilov, Samandar, Wang, Michael Ke, Kurz, Andrea, Belley-Cote, Emilie P., Bhatt, Keyur, Eikelboom, John, Gross, Peter, Lamy, Andre, McGillion, Michael, McIntyre, William, Richards, Toby, Spence, Jessica, Van Helder, Thomas, Whitlock, Richard, and Devereaux, P.J.

Published
2024
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6. Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

Author

Khan, James S., Sessler, Daniel I., Chan, Matthew T. V., Wang, C. Y., Garutti, Ignacio, Szczeklik, Wojciech, Turan, Alparslan, Busse, Jason W., Buckley, D. Norman, Paul, James, McGillion, Michael, Fernández-Riveira, Carmen, Srinathan, Sadeesh K., Shanthanna, Harsha, Gilron, Ian, Jacka, Michael, Jackson, Paul, Hankinson, James, Paniagua, Pilar, Pettit, Shirley, and Devereaux, P. J.

Published
2021
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7. Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis

Author

Jiménez-Xarrié, Elena, primary, Asmarats, Lluis, additional, Roqué-Figuls, Marta, additional, Millán, Xavier, additional, Li, Chi Hion Pedro, additional, Fernández-Peregrina, Estefanía, additional, Sánchez-Ceña, Juan, additional, Massó van Roessel, Albert, additional, Maestre Hittinger, M. Luz, additional, Paniagua, Pilar, additional, and Arzamendi, Dabit, additional

Published
2023
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10. One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery

Author

Sessler, Daniel I., Conen, David, Leslie, Kate, Yusuf, Salim, Popova, Ekaterina, Graham, Michelle, Kurz, Andrea, Villar, Juan Carlos, Mrkobrada, Marko, Sigamani, Alben, Biccard, Bruce M., Meyhoff, Christian S., Parlow, Joel L., Guyatt, Gordon, Xavier, Denis, Chan, Matthew T. V., Kumar, Priya A., Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Torres, David, Wang, C. Y., Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Landoni, Giovanni, Manach, Yannick Le, Whitlock, Richard, Lamy, André, Balasubramanian, Kumar, Gilron, Ian, Turan, Alparslan, Pettit, Shirley, and Devereaux, P. J.

Published
2020
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11. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery :An International Randomized Controlled Trial.

Author

Marcucci, Maura, Painter, Thomas TW, Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I, Chan, Matthew T V, Borges, Flavia K, Leslie, Kate, Duceppe, Emmanuelle, Martínez-Zapata, María José, Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N, Wang, Michael Ke, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo YV, Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X, Short, Timothy TG, Wittmann, Maria, Meyhoff, Christian Sylvest, Amir, Mohammed, Torres, David, Patel, Ameen, Ruetzler, Kurt, Parlow, Joel JL, Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carísi Anne, Lamy, Andre, Jayaram, Raja, Astrakov, Sergey SV, Wu, William Ka Kei, Cheong, Chao Chia, Ayad, Sabry, Kirov, Mikhail M.Y., de Nadal, Miriam, Likhvantsev, Valery VV, Paniagua, Pilar, Aguado, Hector HJ, Maheshwari, Kamal, Whitlock, Richard RP, McGillion, Michael MH, Vincent, Jessica, Copland, Ingrid, Balasubramanian, Kumar, Biccard, Bruce BM, Srinathan, Sadeesh, Ismoilov, Samandar, Pettit, Shirley, Stillo, David, Kurz, Andrea, Belley-Côté, Emilie EP, Spence, Jessica, McIntyre, William WF, Bangdiwala, Shrikant SI, Guyatt, Gordon, Yusuf, Salim, Devereaux, P J, POISE-3 Trial Investigators and Study Groups, Marcucci, Maura, Painter, Thomas TW, Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I, Chan, Matthew T V, Borges, Flavia K, Leslie, Kate, Duceppe, Emmanuelle, Martínez-Zapata, María José, Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N, Wang, Michael Ke, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo YV, Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X, Short, Timothy TG, Wittmann, Maria, Meyhoff, Christian Sylvest, Amir, Mohammed, Torres, David, Patel, Ameen, Ruetzler, Kurt, Parlow, Joel JL, Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carísi Anne, Lamy, Andre, Jayaram, Raja, Astrakov, Sergey SV, Wu, William Ka Kei, Cheong, Chao Chia, Ayad, Sabry, Kirov, Mikhail M.Y., de Nadal, Miriam, Likhvantsev, Valery VV, Paniagua, Pilar, Aguado, Hector HJ, Maheshwari, Kamal, Whitlock, Richard RP, McGillion, Michael MH, Vincent, Jessica, Copland, Ingrid, Balasubramanian, Kumar, Biccard, Bruce BM, Srinathan, Sadeesh, Ismoilov, Samandar, Pettit, Shirley, Stillo, David, Kurz, Andrea, Belley-Côté, Emilie EP, Spence, Jessica, McIntyre, William WF, Bangdiwala, Shrikant SI, Guyatt, Gordon, Yusuf, Salim, Devereaux, P J, and POISE-3 Trial Investigators and Study Groups

Abstract

Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2023

13. Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Author

UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Devereaux, P.J., Marcucci, Maura, Painter, Thomas W., Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Martínez-Zapata, María J., Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N., Wang, Michael K., Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L., Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carisi A., Lamy, Andre, Astrakov, Sergey V., Rao, Mangala, Wu, William K.K., Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Whitlock, Richard P., McGillion, Michael H., Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I., Stillo, David, Gross, Peter L., Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S., Belley-Côté, Emilie P., Spence, Jessica, Richards, Toby, VanHelder, Tomas, McIntyre, William, Guyatt, Gordon, Yusuf, Salim, Leslie, Kate, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Devereaux, P.J., Marcucci, Maura, Painter, Thomas W., Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I., Chan, Matthew T.V., Borges, Flavia K., Martínez-Zapata, María J., Wang, Chew Yin, Xavier, Denis, Ofori, Sandra N., Wang, Michael K., Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V., Szczeklik, Wojciech, Schmartz, Denis, Garg, Amit X., Short, Timothy G., Wittmann, Maria, Meyhoff, Christian S., Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L., Tandon, Vikas, Fleischmann, Edith, Polanczyk, Carisi A., Lamy, Andre, Astrakov, Sergey V., Rao, Mangala, Wu, William K.K., Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V., Paniagua, Pilar, Aguado, Hector J., Whitlock, Richard P., McGillion, Michael H., Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I., Stillo, David, Gross, Peter L., Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S., Belley-Côté, Emilie P., Spence, Jessica, Richards, Toby, VanHelder, Tomas, McIntyre, William, Guyatt, Gordon, Yusuf, Salim, and Leslie, Kate

Abstract

BACKGROUND Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The pri- mary safety outcome was myocardial injury after noncardiac surgery, nonhemor- rhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular out- come, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confi- dence interval [CI], 0.67 to 0.87; absolute difference, −2.6 percentage points; 95% CI, −3.8 to −1.4; two-sided P<0.001 for superiority). A composite cardiovascular outcome event occurred in 649 of 4581 patients (14.2%) in the tranexamic acid group and in 639 of 4601 patients (13.9%) in the placebo group (hazard ratio, 1.02; 95% CI, 0.92 to 1.14; upper boundary of the one-sided 97.5% CI, 1.14; absolute difference, 0.3 per- centage points; 95% CI, −1.1 to 1.7; one-sided P=0.04 for noninferiority). CONCLUSIONS Among patients undergoing noncardiac surgery, the incidence of the com

Published
2022

14. Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury:A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

Author

Garg, Amit X., Cuerden, Meaghan, Aguado, Hector, Amir, Mohammed, Belley-Cote, Emilie P, Bhatt, Keyur, Biccard, Bruce M., Borges, Flavia K., Chan, Matthew, Conen, David, Duceppe, Emmanuelle, Efremov, Sergey, Eikelboom, John, Fleischmann, Edith, Giovanni, Landoni, Gross, Peter, Jayaram, Raja, Kirov, Mikhail, Kleinlugtenbelt, Ydo, Kurz, Andrea, Lamy, Andre, Leslie, Kate, Likhvantsev, Valery, Lomivorotov, Vladimir, Marcucci, Maura, Martínez-Zapata, Maria José, McGillion, Michael, McIntyre, William, Meyhoff, Christian, Ofori, Sandra, Painter, Thomas, Paniagua, Pilar, Parikh, Chirag, Parlow, Joel, Patel, Ameen, Polanczyk, Carisi, Richards, Toby, Roshanov, Pavel, Schmartz, Denis, Sessler, Daniel, Short, Tim, Sontrop, Jessica M., Spence, Jessica, Srinathan, Sadeesh, Stillo, David, Szczeklik, Wojciech, Tandon, Vikas, Torres, David, Van Helder, Thomas, Vincent, Jessica, Wang, C. Y., Wang, Michael, Whitlock, Richard, Wittmann, Maria, Xavier, Denis, Devereaux, P. J., Garg, Amit X., Cuerden, Meaghan, Aguado, Hector, Amir, Mohammed, Belley-Cote, Emilie P, Bhatt, Keyur, Biccard, Bruce M., Borges, Flavia K., Chan, Matthew, Conen, David, Duceppe, Emmanuelle, Efremov, Sergey, Eikelboom, John, Fleischmann, Edith, Giovanni, Landoni, Gross, Peter, Jayaram, Raja, Kirov, Mikhail, Kleinlugtenbelt, Ydo, Kurz, Andrea, Lamy, Andre, Leslie, Kate, Likhvantsev, Valery, Lomivorotov, Vladimir, Marcucci, Maura, Martínez-Zapata, Maria José, McGillion, Michael, McIntyre, William, Meyhoff, Christian, Ofori, Sandra, Painter, Thomas, Paniagua, Pilar, Parikh, Chirag, Parlow, Joel, Patel, Ameen, Polanczyk, Carisi, Richards, Toby, Roshanov, Pavel, Schmartz, Denis, Sessler, Daniel, Short, Tim, Sontrop, Jessica M., Spence, Jessica, Srinathan, Sadeesh, Stillo, David, Szczeklik, Wojciech, Tandon, Vikas, Torres, David, Van Helder, Thomas, Vincent, Jessica, Wang, C. Y., Wang, Michael, Whitlock, Richard, Wittmann, Maria, Xavier, Denis, and Devereaux, P. J.

Abstract

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients’ mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. Control: Patients receive their usual antihypertensive medications before and after surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. Measurements: The primary

Published
2022

15. Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Author

Devereaux, P.J., primary, Marcucci, Maura, additional, Painter, Thomas W., additional, Conen, David, additional, Lomivorotov, Vladimir, additional, Sessler, Daniel I., additional, Chan, Matthew T.V., additional, Borges, Flavia K., additional, Martínez-Zapata, María J., additional, Wang, Chew Yin, additional, Xavier, Denis, additional, Ofori, Sandra N., additional, Wang, Michael K., additional, Efremov, Sergey, additional, Landoni, Giovanni, additional, Kleinlugtenbelt, Ydo V., additional, Szczeklik, Wojciech, additional, Schmartz, Denis, additional, Garg, Amit X., additional, Short, Timothy G., additional, Wittmann, Maria, additional, Meyhoff, Christian S., additional, Amir, Mohammed, additional, Torres, David, additional, Patel, Ameen, additional, Duceppe, Emmanuelle, additional, Ruetzler, Kurt, additional, Parlow, Joel L., additional, Tandon, Vikas, additional, Fleischmann, Edith, additional, Polanczyk, Carisi A., additional, Lamy, Andre, additional, Astrakov, Sergey V., additional, Rao, Mangala, additional, Wu, William K.K., additional, Bhatt, Keyur, additional, de Nadal, Miriam, additional, Likhvantsev, Valery V., additional, Paniagua, Pilar, additional, Aguado, Hector J., additional, Whitlock, Richard P., additional, McGillion, Michael H., additional, Prystajecky, Michael, additional, Vincent, Jessica, additional, Eikelboom, John, additional, Copland, Ingrid, additional, Balasubramanian, Kumar, additional, Turan, Alparslan, additional, Bangdiwala, Shrikant I., additional, Stillo, David, additional, Gross, Peter L., additional, Cafaro, Teresa, additional, Alfonsi, Pascal, additional, Roshanov, Pavel S., additional, Belley-Côté, Emilie P., additional, Spence, Jessica, additional, Richards, Toby, additional, VanHelder, Tomas, additional, McIntyre, William, additional, Guyatt, Gordon, additional, Yusuf, Salim, additional, and Leslie, Kate, additional

Published
2022
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16. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS

Author

Ferrando, Carlos, Suarez-Sipmann, Fernando, Mellado-Artigas, Ricard, Hernández, María, Gea, Alfredo, Arruti, Egoitz, Aldecoa, César, Martínez-Pallí, Graciela, Martínez-González, Miguel A., Slutsky, Arthur S., Villar, Jesús, Graciela, Martínez-Pallí, Mercadal, Jordi, Muñoz, Guido, Mellado, Ricard, Jacas, Adriana, Vendrell, Marina, Sánchez-Etayo, Gerard, Alcón, Amalia, Belda, Isabel, Agustí, Mercé, Carramiñana, Albert, Gracia, Isabel, Panzeri, Miriam, León, Irene, Balust, Jaume, Navarro, Ricard, Arguís, María José, Carretero, Maria José, Ibáñez, Cristina, Perdomo, Juan, López, Antonio, López, Manuel, Cuñat, Tomás, Ubré, Marta, Ojeda, Antonio, Calvo, Andrea, Rivas, Eva, Hurtado, Paola, Pujol, Roger, Martín, Nuria, Tercero, Javier, Sanahuja, Pepe, Magaldi, Marta, Coca, Miquel, del Rio, Elena, Martínez-Ocon, Julia, Masgoret, Paula, Caballero, Angel, Risco, Raquel, Gómez, Lidia, de Riva, Nicolás, Ruiz, Ana, Beatriz, Tena, Jaramillo, Sebastián, Balibrea, Jose María, de Lacy, Francisco Borja, Otero, Ana, Ibarzabal, Ainitze, Bravo, Raquel, Carreras, Anna, Martín-Barreda, Daniel, Alias, Alfonso Jesús, Balaguer, Mariano, Aliaga, Jorge, Almuedo, Alex, Alonso, Joan Ramón, Andrea, Rut, Angelès, Gerard Sergi, Arias, Marilyn, Aziz, Fátima, Badía, Joan Ramon, Barbeta, Enric, Torres, Toni, Batiste, Guillem, Benet, Pau, Borrat, Xavi, Borrell, María, Bragulat, Ernest, Carmona, Inmaculada, Castellà, Manuel, Castro, Pedro, Ceravalls, Joan, Comino, Oscar, Cucciniello, Claudia, De Deray, Clàudia, De Diego, Oriol, De la Matta, Paula, Farrero, Marta, Fernández, Javier, Fernández, Sara, Fernández, Anna, Ferrer, Miquel, Fervienza, Ana, Forga, María Tallo, Forné, Daniel, Galán, Clàudia, Gomez, Andrea, Guasch, Eduard, Tejero, Maria Hernández, Jiménez, Beltrán, Leyes, Pere, López, Teresa, Martínez, José Antonio, Muñoz, Jose, Nicolás, Josep Maria, Ortiz, José Tomás, Peiró, Anna, Pérez, Manuel, Poch, Esteban, Pujol, Margarida, Quintana, Eduard, Ramis, Bartomeu, Reverter, Enric, Rovira, Irene, Ruiz, Pablo, Sandoval, Elena, Schneider, Stefan, Sibila, Oriol, Solé, Carla, Soriano, Alex, Soy, Dolors, Suárez, M., Téllez, Adrián, Toapanta, Néstor David, Torres, Antoni, Urra, Xavier, Bordell, Alicia, Martín, Silvia, Andrés, Judith, Ruiz, Alberto Martínez, Medel, Gonzalo Tamayo, Villasante, Iñaki Bilbao, Clavero, Fernando Iturri, Álvarez, Covadonga Peralta, Herrera, Julia T., Trancho, Andrea García, Mandiola, Iñaki Sainz, Suarez, Carmen Ruano, Bocos, Angela Ruiz, Izagirre, Eneritz Urrutia, de Urbina Fernández, Pablo Ortiz, Apodaka, Naiara, Molano, Leire Prieto, Ganuza, Eunate, Vallinas, Iratxe, de Orte, Karmele, Paniagua, Celia González, Ortiz, Gemma, Pérez, Mireia, López, Marta, Bárcena, Estíbaliz, Urutxurtu, Erik, Maroño, Maria Jesús, Escontrela, Blanca, Ereñozaga, Aitziber, Lasuen, Deiene, Zabal, Ainhoa, Guereca, Ane, Adalia, Ramón, Zattera, Luigi, Hernandez, Irina Adalid, Altuna, Leire Larrañaga, Castells, Aina Serrallonga, Garcia, Adriana Vilchez, Núñez, María, Román, Lorena, Calvo, Francisco Javier Redondo, González, Ruben Villazala, González, Victor Baladron, Faba, Patricia, Montenegro, Omar, Ramírez, Natalia Bejarano, Contreras, Sergio Marcos, Rodríguez, Alejandro Garcia, Vázquez, Saleta Rey, Pérez, Cristina Garcia, Miguelez, Eva Higuera, Blanco, Irene Pérez, Rivera, David García, de la Fuente, Ane Martín, Pardo, Marta, Rodriguez, Vanessa, Bengoetxea, Unai, Ramasco, Fernando, Bernal, Sheila Olga Santidrián, Hernando, Alvar Santa Cruz, Domínguez, Beatriz, Lima, Ana Vázquez, Candela, Ángel, Bambaren, Ismael A. Acevedo, Blanco, Maria Isabel Albala, Montoiro, Paloma Alonso, Utrera, Fernando Álvarez, Esteruelas, Juan Avellanosa, López, Amal Azzam, Balvis, Alberto José Balvis, Martín, María Beltrán, Haserfaty, Jacobo Benatar, Camacho, Alberto Berruezo, Weimer, Laura Betolaza, del Mar Carbonell Soto, Maria, Seral, Cristina Carrasco, Zaballos, Cristina Cerro, Llamas, Elizabeth Claros, Orduna, Pilar Coleta, Forero, Ingrid P. Cortes, Agustín, Pascual, Aliseda, Crespo, de Pablo Pajares, María Angélica, Remesal, Yolanda Díez, Díaz, Trinidad Dorado, Blasco, Noemí Echevarría, Martín, María Elena Elías, Triviño, Javier Felices, López, Natalia Fernández, Martín, Cristina Fernández, Pozuelo, Natalia Ferreiro, Martín, Luis Gajate, Santos, Clara Gallego, Mayo, Diego Gil, Rojo, María Gómez, Cibrián, Claudia González, López, Elena Herrera, Olmedillo, Borja Hinojal, Gallego, Berta Iglesias, Khonsari, Sassan, Ruiz, María Nuria Mane, Arroyo, María Manzanero, Ortega, Ana María Mariscal, Burcio, Sara Martín, del Carmen Martín González, María, Grande, Ascensión Martín, López, Jose Juan Martín, Rabes, Cecilia Martín, Borja, Marcos Martínez, Castro, Nilda Martínez, Pérez, Adolfo Martínez, Matcan, Snejana, Viñas, Cristina Medrano, Herrera, Lisset Miguel, Betancur, Adrián Mira, Carbajo, María Montiel, Moradas, Javier Moya, Pérez, Lorena Muñoz, Murias, Mónica Nuñez, González, Eva Ordiales, Recio, Óscar Ordoñez, Rodriguez, Miguel Ángel Palomero, Roux, Diego Parise, Torres, Lucia Pereira, Lagunas, David Pestaña, Corraliza, Juana María Pinto, Rodrigo, Marian Prieto, Diaz-Regaño, Inmaculada Rodriguez, Esteban, David Rodriguez, Pernia, Víctor Rojas, Saiz, Álvaro Ruigómez, Villarino, Bárbara Saavedra, Palero, Noemí Samaranch, Pérez, Gloria Santos, Pérez, Jaume Serna, Romero, Ana Belén Serrano, López, Jesús Tercero, García, Carlos Tiscar, de la Torre Concostrina, Marta, Mesa, Eva María Ureta, Olarte, Eva Velasco, Martínez, Judith Villahoz, Palacios, Raúl Villalaba, García, Gema Villanueva, de Medeiros, Cristina Vogel, Ovejero, Soraya Gholamian, Orgaz, Marta Vicente, Herradon, Patricia Lloreda, Gómez, Cristina Crespo, Sarmiento-Trujillo, Tatiana, Medina, Noemí García, García, María Martínez, Ramírez, Carles Espinós, Rivero, Nabil Mouhaffel, Gil, Jose Antonio Bernia, Martín, Sonsoles, Moral, María Victoria, Galán, Josefina, Paniagua, Pilar, Pérez, Sergio, Bainac, Albert, Arias, Ana, Ramil, Elsa, Escudero, Jorge, Monedero, Pablo, Cara, Carmen, Lara, Andrea, Mendez Martínez, E., Mendoza, Jorge, Baines, Íñigo Rubio, Montero, Alejandro, Ibañez, Rocío Armero, Pitarch, Juan Vicente Llau, Alcover, Fernando Rauer, Herreros, Cristina Álvarez, Martín, Cyntia Sánchez, Olmos, Lucía López Ocáriz, Moruno, Marta Navas, Montoto, Fernando García, Rodriguez, M. F. Mirón, Gamito, Cristina Hernández, Orejudo, Antonio Barba, Vielma, Luis Gerardo Smith, Marín, Yasmina González, de Borja Amador Penco, Francisco, Domínguez, Marta Donoso, Ramírez, Silvia Esquivel, Carbonell, José Antonio, López, Berta Monleón, Martínez-Castro, Sara, Aguilar, Gerardo, Gestal, María, Casas, Pablo, Rosato, Angel Outeiro, Pan, Andrea Naveiro, Portela, María Alonso, Romar, Adrián García, Rodríguez, Eva Mosquera, Seijo, Diego Ruanova, Maceiras, Pablo Rama, Castro-Ceoane, Francisco, López, Esther Moreno, Gil, Sergio, Antón, Julia Guillén, Tirado, Patricia García-Consuegra, Calvo, Aurora Callau, Lisbona, Laura Forés, Romero, María Carbonell, Gil, Belén Albericio, Jarne, Laura Pradal, Lozano, María Soria, López, Diego Loscos, Abarca, Andrea Patiño, Pérez-Asenjo, Jordi Serrano Javier, Díez-Domínguez, Ángel, Zubizarreta, Ion, Ramos, Jon, Fernández, Iosu, Maseda, Emilio, de la Rica, Alejandro Suárez, Veganzones, Javier, Insausti, Itziar, Sagra, Javier, Carrasco, Sofía Díaz, Feijoo, Ana Montero, Garutti, Julio Yagüe. Ignacio, Parga, Eva Bassas, Garcia, Carmen Deiros, Rosa, Elisenda Pujol, Navarro, Ana Tejedor, Gabernet, Roser Font, Bernat, Maria José, Valls, Meritxell Serra, Garcia-Bernalt, Cristina Cobaleda, Anton, Jesus Fernanz, Sierra, Adriana Aponte, Gomez, Lucia Gil, Vaqueiro, Olaia Guenaga, Marin, Susana Hernandez, Pinzon, Laura Pardo, Aranda, Sira Garcia, Orejuela, Carlos Briones, Sanchez, Edgar Cortes, Fernandez, Alejandro Romero, Sanjosé, Esther Fernández, Garsabal, Patricia Iglesias, Lopez, Guillermo Isidro, Vicol, Ana, Malagon, Sara Espejo, Loewe, Maria Sanabra, Torradeflo, Laura Grau, Alcaide, Lourdes Blanco, Sanclemente, Gloria Buenaventura, Serra Pujol, Pere, Mendoza, Gustavo Cuadros, Konarska, Miroslawa, Almenara, Fedra Bachs, Golska, Agnieszka, Blesa, Aleix Carmona, Serra, Arantxa Mas, Melchor, Javier Ripollés, Moreno, Ana Nieto, Novo, Káteri Chao, López, Sandra Gadín, Moreno, Elena Nieto, Tonal, Bérénice Gutiérrez, de Pablo, Elena Lucena, Yañez, Barbara Algar, Rivero, Beatriz Vázquez, Mateo, Beatriz Nozal, de Retes, Marina, Escoda, Norma Aracil, Mayo, Cristina Gallardo, González, Rosa Sanz, Escobar, Alicia Ruiz, López, Maria Laura Pelegrina, Peña, Marina Valenzuela, Dueñas, David Stolle, Motos, Ane Abad, Abad-Gurumeta, Alfredo, Errazquin, Ana Tirado, Ruiz, Elena Sáez, Perez, Nerea Gómez, de Francisco, González, Borja Bau, Serra, Cesar Morcillo, Higueras, Jessica Souto, Vicente, Rosario, Ferrandis, Raquel, Martín, Silvia Polo, Moncho, Azucena Pajares, Puigdollers, Ignacio Moreno, Cortés, Juan Pérez Artacho, Calvo, Ana Moret, Peña, Ana Pi, Fernández, María Catalán, Varela, Marina, Diaz, Pilar, Chiva, María Isabel Forés, Agulló, A. Javier, Pérez, Antonio, Barrionuevo, María, Medrano, Paloma, Sanz, Cristina, Ortega, Manuel, Galiana, Maria, Margarit, Antoni, del Rio, Válerie Mourre, Muxella, Eva Heras, and Vidal, Anna

Subjects
Mechanical ventilation, ARDS, Acute respiratory distress syndrome, business.industry, Original, medicine.medical_treatment, Hazard ratio, 030208 emergency & critical care medicine, medicine.disease, Critical Care and Intensive Care Medicine, 3. Good health, Coronavirus, 03 medical and health sciences, Plateau pressure, Prone position, 0302 clinical medicine, 030228 respiratory system, Anesthesia, Intensive care, Breathing, Medicine, business, Tidal volume, Outcome
Abstract

Purpose The main characteristics of mechanically ventilated ARDS patients affected with COVID-19, and the adherence to lung-protective ventilation strategies are not well known. We describe characteristics and outcomes of confirmed ARDS in COVID-19 patients managed with invasive mechanical ventilation (MV). Methods This is a multicenter, prospective, observational study in consecutive, mechanically ventilated patients with ARDS (as defined by the Berlin criteria) affected with with COVID-19 (confirmed SARS-CoV-2 infection in nasal or pharyngeal swab specimens), admitted to a network of 36 Spanish and Andorran intensive care units (ICUs) between March 12 and June 1, 2020. We examined the clinical features, ventilatory management, and clinical outcomes of COVID-19 ARDS patients, and compared some results with other relevant studies in non-COVID-19 ARDS patients. Results A total of 742 patients were analysed with complete 28-day outcome data: 128 (17.1%) with mild, 331 (44.6%) with moderate, and 283 (38.1%) with severe ARDS. At baseline, defined as the first day on invasive MV, median (IQR) values were: tidal volume 6.9 (6.3–7.8) ml/kg predicted body weight, positive end-expiratory pressure 12 (11–14) cmH2O. Values of respiratory system compliance 35 (27–45) ml/cmH2O, plateau pressure 25 (22–29) cmH2O, and driving pressure 12 (10–16) cmH2O were similar cto values from non-COVID-19 ARDS observed in other studies. Recruitment maneuvers, prone position and neuromuscular blocking agents were used in 79%, 76% and 72% of patients, respectively. The risk of 28-day mortality was lower in mild ARDS [hazard ratio (RR) 0.56 (95% CI 0.33–0.93), p = 0.026] and moderate ARDS [hazard ratio (RR) 0.69 (95% CI 0.47–0.97), p = 0.035] when compared to severe ARDS. The 28-day mortality was similar to other observational studies in non-COVID-19 ARDS patients. Conclusions In this large series, COVID-19 ARDS patients have features similar to other causes of ARDS, compliance with lung-protective ventilation was high, and the risk of 28-day mortality increased with the degree of ARDS severity. Electronic supplementary material The online version of this article (10.1007/s00134-020-06192-2) contains supplementary material, which is available to authorized users.

Published
2020

17. sj-docx-1-cjk-10.1177_20543581211069225 ��� Supplemental material for Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

Author

Garg, Amit X., Cuerden, Meaghan, Aguado, Hector, Amir, Mohammed, Belley-Cote, Emilie P., Bhatt, Keyur, Biccard, Bruce M., Borges, Flavia K., Chan, Matthew, Conen, David, Duceppe, Emmanuelle, Efremov, Sergey, Eikelboom, John, Fleischmann, Edith, Giovanni, Landoni, Gross, Peter, Jayaram, Raja, Kirov, Mikhail, Kleinlugtenbelt, Ydo, Kurz, Andrea, Lamy, Andre, Leslie, Kate, Likhvantsev, Valery, Lomivorotov, Vladimir, Marcucci, Maura, Mart��nez-Zapata, Maria Jos��, McGillion, Michael, McIntyre, William, Meyhoff, Christian, Ofori, Sandra, Painter, Thomas, Paniagua, Pilar, Parikh, Chirag, Parlow, Joel, Patel, Ameen, Polanczyk, Carisi, Richards, Toby, Roshanov, Pavel, Schmartz, Denis, Sessler, Daniel, Short, Tim, Sontrop, Jessica M., Spence, Jessica, Srinathan, Sadeesh, Stillo, David, Szczeklik, Wojciech, Tandon, Vikas, Torres, David, Van Helder, Thomas, Vincent, Jessica, Wang, C. Y., Wang, Michael, Whitlock, Richard, Wittmann, Maria, Xavier, Denis, and Devereaux, P. J.

Subjects
Medicine
Abstract

Supplemental material, sj-docx-1-cjk-10.1177_20543581211069225 for Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial by Amit X. Garg, Meaghan Cuerden, Hector Aguado, Mohammed Amir, Emilie P. Belley-Cote, Keyur Bhatt, Bruce M. Biccard, Flavia K. Borges, Matthew Chan, David Conen, Emmanuelle Duceppe, Sergey Efremov, John Eikelboom, Edith Fleischmann, Landoni Giovanni, Peter Gross, Raja Jayaram, Mikhail Kirov, Ydo Kleinlugtenbelt, Andrea Kurz, Andre Lamy, Kate Leslie, Valery Likhvantsev, Vladimir Lomivorotov, Maura Marcucci, Maria Jos�� Mart��nez-Zapata, Michael McGillion, William McIntyre, Christian Meyhoff, Sandra Ofori, Thomas Painter, Pilar Paniagua, Chirag Parikh, Joel Parlow, Ameen Patel, Carisi Polanczyk, Toby Richards, Pavel Roshanov, Denis Schmartz, Daniel Sessler, Tim Short, Jessica M. Sontrop, Jessica Spence, Sadeesh Srinathan, David Stillo, Wojciech Szczeklik, Vikas Tandon, David Torres, Thomas Van Helder, Jessica Vincent, C. Y. Wang, Michael Wang, Richard Whitlock, Maria Wittmann, Denis Xavier and P. J. Devereaux in Canadian Journal of Kidney Health and Disease

Published
2022
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18. Effect of a Perioperative Hypotension-Avoidance Strategy Versus a Hypertension-Avoidance Strategy on the Risk of Acute Kidney Injury: A Clinical Research Protocol for a Substudy of the POISE-3 Randomized Clinical Trial

Author

Garg, Amit X., primary, Cuerden, Meaghan, additional, Aguado, Hector, additional, Amir, Mohammed, additional, Belley-Cote, Emilie P., additional, Bhatt, Keyur, additional, Biccard, Bruce M., additional, Borges, Flavia K., additional, Chan, Matthew, additional, Conen, David, additional, Duceppe, Emmanuelle, additional, Efremov, Sergey, additional, Eikelboom, John, additional, Fleischmann, Edith, additional, Giovanni, Landoni, additional, Gross, Peter, additional, Jayaram, Raja, additional, Kirov, Mikhail, additional, Kleinlugtenbelt, Ydo, additional, Kurz, Andrea, additional, Lamy, Andre, additional, Leslie, Kate, additional, Likhvantsev, Valery, additional, Lomivorotov, Vladimir, additional, Marcucci, Maura, additional, Martínez-Zapata, Maria José, additional, McGillion, Michael, additional, McIntyre, William, additional, Meyhoff, Christian, additional, Ofori, Sandra, additional, Painter, Thomas, additional, Paniagua, Pilar, additional, Parikh, Chirag, additional, Parlow, Joel, additional, Patel, Ameen, additional, Polanczyk, Carisi, additional, Richards, Toby, additional, Roshanov, Pavel, additional, Schmartz, Denis, additional, Sessler, Daniel, additional, Short, Tim, additional, Sontrop, Jessica M., additional, Spence, Jessica, additional, Srinathan, Sadeesh, additional, Stillo, David, additional, Szczeklik, Wojciech, additional, Tandon, Vikas, additional, Torres, David, additional, Van Helder, Thomas, additional, Vincent, Jessica, additional, Wang, C. Y., additional, Wang, Michael, additional, Whitlock, Richard, additional, Wittmann, Maria, additional, Xavier, Denis, additional, and Devereaux, P. J., additional

Published
2022
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19. Normalization of blood clotting characteristics using prothrombin complex concentrate, fibrinogen and FXIII in an albumin based fluid: experimental studies in thromboelastometry

Author

Koller, Tobias, Kinast, Nadia, Castellanos, Andres Guilarte, Pérez García, Sergio, Paniagua, Pilar, Vintro, Xavi León, Arranz, Jose Mateo, Seto, Noelia Vilalta, García, Ma. Victòria Moral, Moreno-Castaño, Ana Belén, Aznar-Salatti, Jose, Albaladejo, Gines Escolar, Diaz-Ricart, Maribel, and Universitat Autònoma de Barcelona

Subjects
030204 cardiovascular system & hematology, Critical Care and Intensive Care Medicine, Fibrinogen, Fibrin, 03 medical and health sciences, 0302 clinical medicine, Thrombin, Fluid therapy, Albumins, Humans, Medicine, Platelet, Massive bleeding, Blood Coagulation, Original Research, Chromatography, Factor XIII, biology, Prothrombin complex concentrate, business.industry, Blood transfusion, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Hemostatic resuscitation, 030208 emergency & critical care medicine, lcsh:RC86-88.9, Blood Coagulation Factors, Thrombelastography, Thromboelastometry, Coagulation, Emergency Medicine, biology.protein, Blood Coagulation Tests, business, Plasma substitutes, medicine.drug
Abstract

Background Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with the capability to restore coagulation could be a desirable future treatment component in massive transfusion. Methods Starting from a coagulation factor and blood cell-free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under the presence of platelets was performed for comparability to whole blood conditions. Results Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 min and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 min and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood. Conclusions Combinations of coagulation factor concentrates suspended in albumin solutions can restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion. Trial registration Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.

Published
2021
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20. Clonidine in Patients Undergoing Noncardiac Surgery

Author

Devereaux, P. J., Sessler, Daniel I., Leslie, Kate, Kurz, Andrea, Mrkobrada, Marko, Alonso-Coello, Pablo, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M., Meyhoff, Christian S., Parlow, Joel L., Guyatt, Gordon, Robinson, Andrea, Garg, Amit X., Rodseth, Reitze N., Botto, Fernando, Buse, Giovanna Lurati, Xavier, Denis, Chan, Matthew T.V., Tiboni, Maria, Cook, Deborah, Kumar, Priya A., Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C. Y., VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim

Published
2014
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21. Aspirin in Patients Undergoing Noncardiac Surgery

Author

Devereaux, P. J., Mrkobrada, Marko, Sessler, Daniel I., Leslie, Kate, Alonso-Coello, Pablo, Kurz, Andrea, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M., Meyhoff, Christian S., Parlow, Joel L., Guyatt, Gordon, Robinson, Andrea, Garg, Amit X., Rodseth, Reitze N., Botto, Fernando, Buse, Giovanna Lurati, Xavier, Denis, Chan, Matthew T.V., Tiboni, Maria, Cook, Deborah, Kumar, Priya A., Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C. Y., VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Baigent, Colin, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim

Published
2014
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22. Perception of genetically engineered crops in Paraguay

Author

Benítez Candia, Nidia, primary, Ulke Mayans, Gabriela, additional, Gómez Paniagua, Pilar, additional, Rezende Ribeiro, Claudia, additional, Velázquez Franco, José, additional, Kamada, Daigo, additional, Mendoza de Arbo, Laura, additional, and Fernández Ríos, Danilo, additional

Published
2021
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23. Results of a moderate sedation program with propofol for transesophageal echocardiography performed by non-anesthesiologist professionals.

Author

Li, Chi-Hion, primary, González-Salvado, Violeta, additional, Bertolí, Ester, additional, Viladés, David, additional, Descalzo, Martín, additional, Carreras, Francesc, additional, Leta, Rubén, additional, Cinca, Juan, additional, Capellades, Helena, additional, Cueva, Luisa, additional, and Paniagua, Pilar, additional

Published
2020
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25. Myocardial Injury after Noncardiac Surgery : a Large, International, Prospective Cohort Study Establishing Diagnostic Criteria, Characteristics, Predictors, and 30-day Outcomes

Author

Surgery Patients Cohort Evaluation, Vascular Events In Noncardiac, Botto, Fernando, Alonso-Coello, Pablo, Chan, Matthew T. V., Villar, Juan Carlos, Xavier, Denis, Srinathan, Sadeesh, Guyatt, Gordon H., Cruz, Patricia, Graham, Michelle, Berwanger, Otavio, Pearse, Rupert M., Biccard, Bruce M., Abraham, Valsa, Malaga, German, Hillis, Graham S., Rodseth, Reitze N., Cook, Deborah, Polanczyk, Carisi A., Szczeklik, Wojciech, Sessler, Daniel I., Sheth, Tej, Ackland, Gareth L., Leuwer, Martin, Garg, Amit X., LeManach, Yannick, Pettit, Shirley, Heels-Ansdell, Diane, LuratiBuse, Giovanna, Walsh, Michael, Sapsford, Robert, Schunemann, Holger J., Kurz, Andrea, Thomas, Sabu, Mrkobrada, Marko, Thabane, Lehana, Gerstein, Hertzel, Paniagua, Pilar, Nagele, Peter, Raina, Parminder, Yusuf, Salim, and Devereaux, P.-J.

Published
2014

27. Aspirin in patients undergoing noncardiac surgery

Author

UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Mrkobrada, Marko, Sessler, Daniel I, Leslie, Kate, Alonso-Coello, Pablo, Kurz, Andrea, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Baigent, Colin, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, Yusuf, Salim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Mrkobrada, Marko, Sessler, Daniel I, Leslie, Kate, Alonso-Coello, Pablo, Kurz, Andrea, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, VanHelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Baigent, Colin, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim

Abstract

BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. CONCLUSIONS: Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

Published
2014

28. Clonidine in patients undergoing noncardiac surgery

Author

UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Sessler, Daniel I, Leslie, Kate, Kurz, Andrea, Mrkobrada, Marko, Alonso-Coello, Pablo, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, Vanhelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, Yusuf, Salim, UCL - SSS/IONS/CEMO - Pôle Cellulaire et moléculaire, UCL - (SLuc) Service d'anesthésiologie, Devereaux, P J, Sessler, Daniel I, Leslie, Kate, Kurz, Andrea, Mrkobrada, Marko, Alonso-Coello, Pablo, Villar, Juan Carlos, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Robinson, Andrea, Garg, Amit X, Rodseth, Reitze N, Botto, Fernando, Lurati Buse, Giovanna, Xavier, Denis, Chan, Matthew T V, Tiboni, Maria, Cook, Deborah, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Eikelboom, John, Mizera, Richard, Torres, David, Wang, C Y, Vanhelder, Tomas, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Graham, Michelle, Pasin, Laura, Le Manach, Yannick, Gao, Peggy, Pogue, Janice, Whitlock, Richard, Lamy, André, Kearon, Clive, Chow, Clara, Pettit, Shirley, Chrolavicius, Susan, and Yusuf, Salim

Abstract

BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a blinded, randomized trial with a 2-by-2 factorial design to allow separate evaluation of low-dose clonidine versus placebo and low-dose aspirin versus placebo in patients with, or at risk for, atherosclerotic disease who were undergoing noncardiac surgery. A total of 10,010 patients at 135 centers in 23 countries were enrolled. For the comparison of clonidine with placebo, patients were randomly assigned to receive clonidine (0.2 mg per day) or placebo just before surgery, with the study drug continued until 72 hours after surgery. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. RESULTS: Clonidine, as compared with placebo, did not reduce the number of primary-outcome events (367 and 339, respectively; hazard ratio with clonidine, 1.08; 95% confidence interval [CI], 0.93 to 1.26; P=0.29). Myocardial infarction occurred in 329 patients (6.6%) assigned to clonidine and in 295 patients (5.9%) assigned to placebo (hazard ratio, 1.11; 95% CI, 0.95 to 1.30; P=0.18). Significantly more patients in the clonidine group than in the placebo group had clinically important hypotension (2385 patients [47.6%] vs. 1854 patients [37.1%]; hazard ratio 1.32; 95% CI, 1.24 to 1.40; P<0.001). Clonidine, as compared with placebo, was associated with an increased rate of nonfatal cardiac arrest (0.3% [16 patients] vs. 0.1% [5 patients]; hazard ratio, 3.20; 95% CI, 1.17 to 8.73; P=0.02). CONCLUSIONS: Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac

Published
2014

30. Abstract 18519: Withdrawal of Antiplatelet Therapy Results in Worse Short-term Prognosis in Patients Undergoing Elective Major Noncardiac Surgery

Author

álvarez-García, Jesús, primary, Vives-Borrás, Miquel, additional, Llao, Joan I, additional, Ferrero-Gregori, Andreu, additional, Bausili, Marc, additional, Díaz, Rubén, additional, Gil, María A, additional, Moral, Victoria, additional, Paniagua, Pilar, additional, Rodriguez, Mireia, additional, Urrutia, Mónica C, additional, Sionis, Alessandro, additional, and Pelaez, Xavier, additional

Published
2014
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31. Abstract 17765: Mild Preoperative Anemia is an Independent Predictor of Mortality and Cardiovascular Events in Patients Undergoing Elective Major Noncardiac Surgery

Author

álvarez-García, Jesús, primary, Vives-Borrás, Miquel, additional, Llao, Joan I, additional, Ferrero-Gregori, Andreu, additional, Bausili, Marc, additional, Díaz, Rubén, additional, Gil, María A, additional, Moral, Victoria, additional, Paniagua, Pilar, additional, Rodriguez, Mireia, additional, Urrutia, Mónica C, additional, Sionis, Alessandro, additional, and Pelaez, Xavier, additional

Published
2014
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40. Propofol sedation administered by cardiologists in echocardiography studies

Author

Li, Chi-Hion, González-Salvado, Violeta, Bertolí, Ester, Viladés, David, Descalzo, Martín, Carreras, Francesc, Leta, Rubén, Cinca, Juan, Capellades, Helena, Cueva, Luisa, and Paniagua, Pilar

Abstract

The advantages of sedation in patients undergoing transesophageal echocardiography (TEE) are well established, but the increasing number of TEE studies may limit the capacity of Anesthesiology services. In this study we analyze the effectiveness and safety of a moderate sedation program carried out by non-anesthesiologist professionals (NAP).

Published
2021
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43. Tranexamic Acid in Patients Undergoing Noncardiac Surgery

Author

P J, Devereaux, Maura, Marcucci, Thomas W, Painter, David, Conen, Vladimir, Lomivorotov, Daniel I, Sessler, Matthew T V, Chan, Flavia K, Borges, María J, Martínez-Zapata, Chew Yin, Wang, Denis, Xavier, Sandra N, Ofori, Michael K, Wang, Sergey, Efremov, Giovanni, Landoni, Ydo V, Kleinlugtenbelt, Wojciech, Szczeklik, Denis, Schmartz, Amit X, Garg, Timothy G, Short, Maria, Wittmann, Christian S, Meyhoff, Mohammed, Amir, David, Torres, Ameen, Patel, Emmanuelle, Duceppe, Kurt, Ruetzler, Joel L, Parlow, Vikas, Tandon, Edith, Fleischmann, Carisi A, Polanczyk, Andre, Lamy, Sergey V, Astrakov, Mangala, Rao, William K K, Wu, Keyur, Bhatt, Miriam, de Nadal, Valery V, Likhvantsev, Pilar, Paniagua, Hector J, Aguado, Richard P, Whitlock, Michael H, McGillion, Michael, Prystajecky, Jessica, Vincent, John, Eikelboom, Ingrid, Copland, Kumar, Balasubramanian, Alparslan, Turan, Shrikant I, Bangdiwala, David, Stillo, Peter L, Gross, Teresa, Cafaro, Pascal, Alfonsi, Pavel S, Roshanov, Emilie P, Belley-Côté, Jessica, Spence, Toby, Richards, Tomas, VanHelder, William, McIntyre, Gordon, Guyatt, Salim, Yusuf, Kate, Leslie, Erin, Hittesdorf, UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire, Devereaux, P J, Marcucci, Maura, Painter, Thomas W, Conen, David, Lomivorotov, Vladimir, Sessler, Daniel I, Chan, Matthew T V, Borges, Flavia K, Martínez-Zapata, María J, Wang, Chew-Yin, Xavier, Deni, Ofori, Sandra N, Wang, Michael K, Efremov, Sergey, Landoni, Giovanni, Kleinlugtenbelt, Ydo V, Szczeklik, Wojciech, Schmartz, Deni, Garg, Amit X, Short, Timothy G, Wittmann, Maria, Meyhoff, Christian S, Amir, Mohammed, Torres, David, Patel, Ameen, Duceppe, Emmanuelle, Ruetzler, Kurt, Parlow, Joel L, Tandon, Vika, Fleischmann, Edith, Polanczyk, Carisi A, Lamy, Andre, Astrakov, Sergey V, Rao, Mangala, Wu, William K K, Bhatt, Keyur, de Nadal, Miriam, Likhvantsev, Valery V, Paniagua, Pilar, Aguado, Hector J, Whitlock, Richard P, Mcgillion, Michael H, Prystajecky, Michael, Vincent, Jessica, Eikelboom, John, Copland, Ingrid, Balasubramanian, Kumar, Turan, Alparslan, Bangdiwala, Shrikant I, Stillo, David, Gross, Peter L, Cafaro, Teresa, Alfonsi, Pascal, Roshanov, Pavel S, Belley-Côté, Emilie P, Spence, Jessica, Richards, Toby, Vanhelder, Toma, Mcintyre, William, Guyatt, Gordon, Yusuf, Salim, Leslie, Kate, and Anesthesiology

Subjects
BLOOD-TRANSFUSION, HEMORRHAGE, Canada, Tranexamic Acid, MORTALITY, Surgical Procedures, Operative, BIMS, Humans, Hemorrhage, Thrombosis, General Medicine, Antifibrinolytic Agents
Abstract

BACKGROUND Perioperative bleeding is common in patients undergoing noncardiac surgery. Tranexamic acid is an antifibrinolytic drug that may safely decrease such bleeding. METHODS We conducted a trial involving patients undergoing noncardiac surgery. Patients were randomly assigned to receive tranexamic acid (1-g intravenous bolus) or placebo at the start and end of surgery (reported here) and, with the use of a partial factorial design, a hypotension-avoidance or hypertension-avoidance strategy (not reported here). The primary efficacy outcome was life-threatening bleeding, major bleeding, or bleeding into a critical organ (composite bleeding outcome) at 30 days. The pri- mary safety outcome was myocardial injury after noncardiac surgery, nonhemor- rhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism (composite cardiovascular outcome) at 30 days. To establish the noninferiority of tranexamic acid to placebo for the composite cardiovascular out- come, the upper boundary of the one-sided 97.5% confidence interval for the hazard ratio had to be below 1.125, and the one-sided P value had to be less than 0.025. RESULTS A total of 9535 patients underwent randomization. A composite bleeding outcome event occurred in 433 of 4757 patients (9.1%) in the tranexamic acid group and in 561 of 4778 patients (11.7%) in the placebo group (hazard ratio, 0.76; 95% confi- dence interval [CI], 0.67 to 0.87; absolute difference, −2.6 percentage points; 95% CI, −3.8 to −1.4; two-sided P

Published
2022
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44. One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery

Author

Patrice Forget, Joel L. Parlow, Christian S. Meyhoff, Yannick Le Manach, Alben Sigamani, Matthew T. V. Chan, Mohammed Amir, Giovanni Landoni, Bruce M Biccard, Alparslan Turan, Andrea Kurz, Denis Xavier, Richard P. Whitlock, Gordon H. Guyatt, Germán Málaga, Ekaterina Popova, Juan Carlos Villar, Andre Lamy, David Torres, Kate Leslie, Daniel I. Sessler, Priya A. Kumar, Kumar Balasubramanian, Ian Gilron, Sadeesh Srinathan, Marko Mrkobrada, Michelle M. Graham, Pilar Paniagua, Chew Yin Wang, Shirley Pettit, Edith Fleischmann, Salim Yusuf, Otavio Berwanger, Philip J. Devereaux, David Conen, Sessler, Daniel I, Conen, David, Leslie, Kate, Yusuf, Salim, Popova, Ekaterina, Graham, Michelle, Kurz, Andrea, Villar, Juan Carlo, Mrkobrada, Marko, Sigamani, Alben, Biccard, Bruce M, Meyhoff, Christian S, Parlow, Joel L, Guyatt, Gordon, Xavier, Deni, Chan, Matthew T V, Kumar, Priya A, Forget, Patrice, Malaga, German, Fleischmann, Edith, Amir, Mohammed, Torres, David, Wang, C Y, Paniagua, Pilar, Berwanger, Otavio, Srinathan, Sadeesh, Landoni, Giovanni, Manach, Yannick Le, Whitlock, Richard, Lamy, André, Balasubramanian, Kumar, Gilron, Ian, Turan, Alparslan, Pettit, Shirley, and Devereaux, P J

Subjects
Male, Internationality, Time Factors, medicine.medical_treatment, Myocardial Infarction, Infarction, 030204 cardiovascular system & hematology, Placebo, Clonidine, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Aged, Aspirin, Analgesics, business.industry, Hazard ratio, Anti-Inflammatory Agents, Non-Steroidal, Percutaneous coronary intervention, Perioperative, Middle Aged, medicine.disease, Anesthesiology and Pain Medicine, Anesthesia, Female, business, medicine.drug, Follow-Up Studies
Abstract

Background The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown. Methods The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h. Results Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1). Conclusions Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Published
2020

45. Association between Complications and Death within 30 days after General Surgery: A Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) substudy.

Author

Park LJ, Borges FK, Ofori S, Nenshi R, Jacka M, Heels-Ansdell D, Bogach J, Vogt K, Chan MT, Verghese A, Polanczyk CA, Skinner D, Asencio JM, Paniagua P, Rosen M, Serrano PE, Marcaccio MJ, Simunovic M, Thabane L, and Devereaux PJ

Abstract

Objective: To determine the epidemiology of post-operative complications among general surgery patients, inform their relationships with 30-day mortality, and determine the attributable fraction of death of each postoperative complication., Background: The contemporary causes of post-operative mortality among general surgery patients are not well characterized., Methods: VISION is a prospective cohort study of adult non-cardiac surgery patients across 28 centres in 14 countries, who were followed for 30 days after surgery. For the subset of general surgery patients, a cox proportional hazards model was used to determine associations between various surgical complications and post-operative mortality. The analyses were adjusted for preoperative and surgical variables. Results were reported in adjusted hazard ratios (HR) with 95% confidence intervals (CI)., Results: Among 7950 patients included in the study, 240 (3.0%) patients died within 30 days of surgery. Five post-operative complications (myocardial injury after non-cardiac surgery [MINS], major bleeding, sepsis, stroke, and acute kidney injury resulting in dialysis) were independently associated with death. Complications associated with the largest attributable fraction (AF) of post-operative mortality (i.e., percentage of deaths in the cohort that can be attributed to each complication, if causality were established) were major bleeding (n=1454, 18.3%, HR 2.49 95%CI 1.87-3.33, P<0.001, AF 21.2%), sepsis (n=783, 9.9%, HR 6.52, 95%CI 4.72-9.01, P<0.001, AF 15.6%), and MINS (n=980, 12.3%, HR 2.00, 95%CI 1.50-2.67, P<0.001, AF 14.4%)., Conclusion: The complications most associated with 30-day mortality following general surgery are major bleeding, sepsis, and MINS. These findings may guide the development of mitigating strategies, including prophylaxis for perioperative bleeding., Competing Interests: Conflict of Interest Statement: Based on study questions Dr. Devereaux has originated and grants he has written, he has received grants from Abbott Diagnostics, AOP Pharma, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers-Squibb, CloudDX, Coviden, Octapharma, Philips Healthcare, Roche Diagnostics, Siemens and Stryker. Dr. Devereaux has participated in advisory board meetings for GlaxoSmithKline, Boehringer Ingelheim, Bayer and Quidel Canada. He attended an expert panel meeting with AstraZeneca and Boehringer Ingelheim and he was Consultant for a call with Roche Pharma and consultant work with Abbott Diagnostics, Astra Zeneca, Renibus, Roche Canada and Trimedic. He has also been invited as a speaker with Bayer Inc, Novartis Pharma Canada, and Abbott Diagnostics. Dr. Rosen has no conflicts of interest relevant to this work but discloses the following: ACHQC Medical Director, Telabio grant support, Ariste Medical Stock options., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Published
2024
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46. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery : An International Randomized Controlled Trial.

Author

Marcucci M, Painter TW, Conen D, Lomivorotov V, Sessler DI, Chan MTV, Borges FK, Leslie K, Duceppe E, Martínez-Zapata MJ, Wang CY, Xavier D, Ofori SN, Wang MK, Efremov S, Landoni G, Kleinlugtenbelt YV, Szczeklik W, Schmartz D, Garg AX, Short TG, Wittmann M, Meyhoff CS, Amir M, Torres D, Patel A, Ruetzler K, Parlow JL, Tandon V, Fleischmann E, Polanczyk CA, Lamy A, Jayaram R, Astrakov SV, Wu WKK, Cheong CC, Ayad S, Kirov M, de Nadal M, Likhvantsev VV, Paniagua P, Aguado HJ, Maheshwari K, Whitlock RP, McGillion MH, Vincent J, Copland I, Balasubramanian K, Biccard BM, Srinathan S, Ismoilov S, Pettit S, Stillo D, Kurz A, Belley-Côté EP, Spence J, McIntyre WF, Bangdiwala SI, Guyatt G, Yusuf S, and Devereaux PJ

Subjects
Humans, Antihypertensive Agents therapeutic use, Postoperative Complications epidemiology, Canada, Hypotension etiology, Hypotension prevention & control, Hypertension drug therapy
Abstract

Background: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively., Objective: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery., Design: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723)., Setting: 110 hospitals in 22 countries., Patients: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications., Intervention: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery., Measurements: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment., Results: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P  = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term., Limitation: Adherence to the assigned strategies was suboptimal; however, results were consistent across different adherence levels., Conclusion: In patients having noncardiac surgery, our hypotension-avoidance and hypertension-avoidance strategies resulted in a similar incidence of major vascular complications., Primary Funding Source: Canadian Institutes of Health Research, National Health and Medical Research Council (Australia), and Research Grant Council of Hong Kong., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3157.

Published
2023
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47. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes.

Author

Botto F, Alonso-Coello P, Chan MT, Villar JC, Xavier D, Srinathan S, Guyatt G, Cruz P, Graham M, Wang CY, Berwanger O, Pearse RM, Biccard BM, Abraham V, Malaga G, Hillis GS, Rodseth RN, Cook D, Polanczyk CA, Szczeklik W, Sessler DI, Sheth T, Ackland GL, Leuwer M, Garg AX, Lemanach Y, Pettit S, Heels-Ansdell D, Luratibuse G, Walsh M, Sapsford R, Schünemann HJ, Kurz A, Thomas S, Mrkobrada M, Thabane L, Gerstein H, Paniagua P, Nagele P, Raina P, Yusuf S, Devereaux PJ, Devereaux PJ, Sessler DI, Walsh M, Guyatt G, McQueen MJ, Bhandari M, Cook D, Bosch J, Buckley N, Yusuf S, Chow CK, Hillis GS, Halliwell R, Li S, Lee VW, Mooney J, Polanczyk CA, Furtado MV, Berwanger O, Suzumura E, Santucci E, Leite K, Santo JA, Jardim CA, Cavalcanti AB, Guimaraes HP, Jacka MJ, Graham M, McAlister F, McMurtry S, Townsend D, Pannu N, Bagshaw S, Bessissow A, Bhandari M, Duceppe E, Eikelboom J, Ganame J, Hankinson J, Hill S, Jolly S, Lamy A, Ling E, Magloire P, Pare G, Reddy D, Szalay D, Tittley J, Weitz J, Whitlock R, Darvish-Kazim S, Debeer J, Kavsak P, Kearon C, Mizera R, O'Donnell M, McQueen M, Pinthus J, Ribas S, Simunovic M, Tandon V, Vanhelder T, Winemaker M, Gerstein H, McDonald S, O'Bryne P, Patel A, Paul J, Punthakee Z, Raymer K, Salehian O, Spencer F, Walter S, Worster A, Adili A, Clase C, Cook D, Crowther M, Douketis J, Gangji A, Jackson P, Lim W, Lovrics P, Mazzadi S, Orovan W, Rudkowski J, Soth M, Tiboni M, Acedillo R, Garg A, Hildebrand A, Lam N, Macneil D, Mrkobrada M, Roshanov PS, Srinathan SK, Ramsey C, John PS, Thorlacius L, Siddiqui FS, Grocott HP, McKay A, Lee TW, Amadeo R, Funk D, McDonald H, Zacharias J, Villar JC, Cortés OL, Chaparro MS, Vásquez S, Castañeda A, Ferreira S, Coriat P, Monneret D, Goarin JP, Esteve CI, Royer C, Daas G, Chan MT, Choi GY, Gin T, Lit LC, Xavier D, Sigamani A, Faruqui A, Dhanpal R, Almeida S, Cherian J, Furruqh S, Abraham V, Afzal L, George P, Mala S, Schünemann H, Muti P, Vizza E, Wang CY, Ong GS, Mansor M, Tan AS, Shariffuddin II, Vasanthan V, Hashim NH, Undok AW, Ki U, Lai HY, Ahmad WA, Razack AH, Malaga G, Valderrama-Victoria V, Loza-Herrera JD, De Los Angeles Lazo M, Rotta-Rotta A, Szczeklik W, Sokolowska B, Musial J, Gorka J, Iwaszczuk P, Kozka M, Chwala M, Raczek M, Mrowiecki T, Kaczmarek B, Biccard B, Cassimjee H, Gopalan D, Kisten T, Mugabi A, Naidoo P, Naidoo R, Rodseth R, Skinner D, Torborg A, Paniagua P, Urrutia G, Maestre ML, Santaló M, Gonzalez R, Font A, Martínez C, Pelaez X, De Antonio M, Villamor JM, García JA, Ferré MJ, Popova E, Alonso-Coello P, Garutti I, Cruz P, Fernández C, Palencia M, Díaz S, Del Castillo T, Varela A, de Miguel A, Muñoz M, Piñeiro P, Cusati G, Del Barrio M, Membrillo MJ, Orozco D, Reyes F, Sapsford RJ, Barth J, Scott J, Hall A, Howell S, Lobley M, Woods J, Howard S, Fletcher J, Dewhirst N, Williams C, Rushton A, Welters I, Leuwer M, Pearse R, Ackland G, Khan A, Niebrzegowska E, Benton S, Wragg A, Archbold A, Smith A, McAlees E, Ramballi C, Macdonald N, Januszewska M, Stephens R, Reyes A, Paredes LG, Sultan P, Cain D, Whittle J, Del Arroyo AG, Sessler DI, Kurz A, Sun Z, Finnegan PS, Egan C, Honar H, Shahinyan A, Panjasawatwong K, Fu AY, Wang S, Reineks E, Nagele P, Blood J, Kalin M, Gibson D, and Wildes T

Subjects
Age Distribution, Aged, Cohort Studies, Humans, Male, Middle Aged, Myocardial Ischemia blood, Postoperative Complications blood, Prognosis, Prospective Studies, Troponin T blood, Myocardial Ischemia diagnosis, Myocardial Ischemia epidemiology, Patient Outcome Assessment, Postoperative Complications diagnosis, Postoperative Complications epidemiology, Surgical Procedures, Operative
Abstract

Background: Myocardial injury after noncardiac surgery (MINS) was defined as prognostically relevant myocardial injury due to ischemia that occurs during or within 30 days after noncardiac surgery. The study's four objectives were to determine the diagnostic criteria, characteristics, predictors, and 30-day outcomes of MINS., Methods: In this international, prospective cohort study of 15,065 patients aged 45 yr or older who underwent in-patient noncardiac surgery, troponin T was measured during the first 3 postoperative days. Patients with a troponin T level of 0.04 ng/ml or greater (elevated "abnormal" laboratory threshold) were assessed for ischemic features (i.e., ischemic symptoms and electrocardiography findings). Patients adjudicated as having a nonischemic troponin elevation (e.g., sepsis) were excluded. To establish diagnostic criteria for MINS, the authors used Cox regression analyses in which the dependent variable was 30-day mortality (260 deaths) and independent variables included preoperative variables, perioperative complications, and potential MINS diagnostic criteria., Results: An elevated troponin after noncardiac surgery, irrespective of the presence of an ischemic feature, independently predicted 30-day mortality. Therefore, the authors' diagnostic criterion for MINS was a peak troponin T level of 0.03 ng/ml or greater judged due to myocardial ischemia. MINS was an independent predictor of 30-day mortality (adjusted hazard ratio, 3.87; 95% CI, 2.96-5.08) and had the highest population-attributable risk (34.0%, 95% CI, 26.6-41.5) of the perioperative complications. Twelve hundred patients (8.0%) suffered MINS, and 58.2% of these patients would not have fulfilled the universal definition of myocardial infarction. Only 15.8% of patients with MINS experienced an ischemic symptom., Conclusion: Among adults undergoing noncardiac surgery, MINS is common and associated with substantial mortality.

Published
2014
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49. Should physicians initiate beta-blocker therapy in patients undergoing non-cardiac surgery? Insights from the POISE trial.

Author

Alonso-Coello P, Paniagua P, Mizera R, and Devereaux PJ

Subjects
Adrenergic beta-Antagonists administration & dosage, Clinical Competence, Humans, Metoprolol administration & dosage, Metoprolol adverse effects, Metoprolol therapeutic use, Randomized Controlled Trials as Topic, Research Design, Adrenergic beta-Antagonists therapeutic use, Cardiovascular Diseases prevention & control, Intraoperative Complications prevention & control, Metoprolol analogs & derivatives, Perioperative Care methods, Preoperative Care methods
Published
2008

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