Perioperative RAAS Antagonists Evidence and Controversy

Perioperative use of RAAS Antagonists: Evidence and Controversy Moises Auron MD, FAAP Department of Hospital Medicine Cleveland Clinic

Objectives ,[object Object],[object Object]

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object]

RAAS antagonists: indications ,[object Object],[object Object],[object Object],[object Object],[object Object],Ann Intern Med. 2008 Jan 1;148(1):16-29. J Card Fail. 2008 Apr;14(3):181-8. J Gen Intern Med. 2006 Dec;21(12):1242-7. Lancet. 2005 Dec 10;366(9502):2026-33. Curr Pharm Des. 2007;13(13):1335-45.

RAAS antagonists and surgery ,[object Object],[object Object],[object Object],[object Object],Anesth Analg. 1999 Nov;89(5):1143-55. Anesth Analg. 2001 Nov;93(5):1111-5.

J Intern Med. 2008 Sep;264(3):224-36.

Pharmacology of RAAS antagonists: perioperative implications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation. 2000 Jul 18;102(3):351-6. J Intern Med. 2008 Sep;264(3):224-36.

Effects of anesthesia on the BP ,[object Object],[object Object],[object Object],Curr Pharm Des. 2003;9(9):763-76

Intra-operative BP ,[object Object],[object Object],[object Object],[object Object],[object Object],Curr Pharm Des. 2003;9(9):763-76

Intra-operative BP ,[object Object],[object Object],[object Object],[object Object]

Pharmacogenomics of RAAS ,[object Object],[object Object],[object Object],[object Object],[object Object],Circulation. 2007 Feb 13;115(6):725-32. J Mol Med. 2008 Jun;86(6):637-41.

ACEI Am J Health Syst Pharm. 2004 May 1;61(9):899-912.

ARB Circulation 2001;103;904-912.

[object Object],[object Object]

Cleveland Clinic: IMPACT ,[object Object],[object Object],Cleve Clin J Med. 2006 Mar;73 Suppl 1:S82-7.

[object Object],[object Object],[object Object],[object Object],McCarthy Anaesthesia. 1990 Mar;45(3):243-5.

Coriat ,[object Object],[object Object],[object Object],[object Object],Anesthesiology. 1994 Aug;81(2):299-307.

Brabant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anesth Analg. 1999 Dec;89(6):1388-92.

Bertrand ,[object Object],[object Object],[object Object],[object Object],[object Object],Anesth Analg. 2001 Jan;92(1):26-30.

Comfere ,[object Object],[object Object],Anesth Analg. 2005 Mar;100(3):636-44.

Shirmer ,[object Object],[object Object],[object Object],[object Object],Anaesthesist. 2007 Jun;56(6):557-61.

Licker ,[object Object],[object Object],[object Object],[object Object],[object Object],Can J Anaesth. 2000 May;47(5):433-40.

Kheterpal ,[object Object],[object Object],[object Object],J Cardiothorac Vasc Anesth. 2008 Apr;22(2):180-6.

Rosenman ,[object Object],[object Object],[object Object],[object Object],[object Object],J Hosp Med. 2008 Jul;3(4):319-25.

Metaanalysis: Hypotension J Hosp Med. 2008;3:319–325

Metaanalysis: AMI J Hosp Med. 2008;3:319–325

EVIDENCE SUPPORTING RAAS-ANTAGONISTS

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Anesth Analg. 1995 Mar;80(3):583-90. Drugs. 2007;67(7):1053-76.

[object Object],[object Object],[object Object],[object Object],Tohmo and Karanko J Neurosurg Anesthesiol. 1993 Jan;5(1):13-21. Acta Anaesthesiol Scand. 1996 Jan;40(1):132-3.

ACE and Atrial Fibrillation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eur J Cardiothorac Surg. 2007 May;31(5):817-20.

Boldt ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Heart. 1996 Sep;76(3):207-13.

Pigott ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Br J Anaesth. 1999 Nov;83(5):715-20.

Colson ,[object Object],[object Object],[object Object],Anesthesiology. 1990 Jan;72(1):23-7.

Licker ,[object Object],[object Object],[object Object],[object Object],Br J Anaesth. 1996 May;76(5):632-9.

Benedetto ,[object Object],[object Object],[object Object],[object Object],[object Object],Ann Thorac Surg. 2008 Oct;86(4):1160-5.

Cittanova ,[object Object],[object Object],Anesth Analg. 2001 Nov;93(5):1111-5.

Kincaid ,[object Object],[object Object],Ann Thorac Surg. 2005 Oct;80(4):1388-93

[object Object],[object Object],[object Object],Eur J Anaesthesiol. 1992 Jan;9(1):63-9. Anesthesiology. 1994 May;80(5):992-9.

[object Object],[object Object],[object Object],[object Object],[object Object],Acta Anaesthesiol Scand. 2003 Aug;47(7):891-6.

Aliskiren ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Am Coll Cardiol. 2008 Feb 5;51(5):519-28. Circulation. 2008 Aug 12;118(7):773-84. Am J Health Syst Pharm. 2008 Jul 15;65(14):1323-32.

Conclusions ,[object Object],[object Object],[object Object]

Conclusions (cont.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Perioperative RAAS Antagonists Evidence and Controversy

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Perioperative RAAS Antagonists Evidence and Controversy