Many patients who undergo major surgery have a history of hypertension, diabetes, and heart failure. They may receive chronic treatment with a renin-angiotensin system inhibitor (RASI), namely an angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin receptor blocker (ARB). Due to a lack of conclusive data from randomized trials, the question of whether to stop ISRAs before noncardiac surgery is uncertain.
The goal of the STOP-or-NOT trial was to remove uncertainty on this issue.
The STOP-or-NOT trial, which included a total of 2,222 patients with an average age of 67 years, treated for more than three months with an ISRA, is an open, randomized, controlled trial conducted in 40 centers. French. The patients were divided into two groups:
- Group 1: patients (1,115) having to stop ISRA 48 hours before surgery, i.e. receiving the last dose three days before the procedure
- Group 2: patients (1,107) required to continue ISRA until the date of the intervention
In both groups, it was recommended to resume treatment with ISRA as soon as possible after the operation, when the oral route was considered possible.
In this trial, discontinuation of ISRA before noncardiac surgery resulted in a similar rate of major postoperative complications compared with continued administration of the renin-angiotensin system inhibitor. The STOP-or-NOT trial therefore showed that there is no need to stop renin-angiotensin system inhibitors before non-cardiac surgery.
To find out more: read the press release
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