Universidad Peruana Cayetano Heredia

Clonidine in patients undergoing noncardiac surgery

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dc.contributor.author Devereaux, P.J.
dc.contributor.author Sessler, D.I.
dc.contributor.author Leslie, K.
dc.contributor.author Kurz, A.
dc.contributor.author Mrkobrada, M.
dc.contributor.author Alonso-Coello, P.
dc.contributor.author Villar, J.C.
dc.contributor.author Sigamani, A.
dc.contributor.author Biccard, B.M.
dc.contributor.author Meyhoff, C.S.
dc.contributor.author Parlow, J.L.
dc.contributor.author Guyatt, G.
dc.contributor.author Robinson, A.
dc.contributor.author Garg, A.X.
dc.contributor.author Rodseth, R.N.
dc.contributor.author Botto, F.
dc.contributor.author Lurati Buse, G.
dc.contributor.author Xavier, D.
dc.contributor.author Chan, M.T.V.
dc.contributor.author Tiboni, M.
dc.contributor.author Cook, D.
dc.contributor.author Kumar, P.A.
dc.contributor.author Forget, P.
dc.contributor.author Málaga Rodríguez, Germán Javier
dc.contributor.author Fleischmann, E.
dc.contributor.author Amir, M.
dc.contributor.author Eikelboom, J.
dc.contributor.author Mizera, R.
dc.contributor.author Torres, D.
dc.contributor.author Wang, C.Y.
dc.contributor.author VanHelder, T.
dc.contributor.author Paniagua, P.
dc.contributor.author Berwanger, O.
dc.contributor.author Srinathan, S.
dc.contributor.author Graham, M.
dc.contributor.author Pasin, L.
dc.contributor.author Le Manach, Y.
dc.contributor.author Gao, P.
dc.contributor.author Pogue, J.
dc.contributor.author Whitlock, R.
dc.contributor.author Lamy, A.
dc.contributor.author Kearon, C.
dc.contributor.author Chow, C.
dc.contributor.author Pettit, S.
dc.contributor.author Chrolavicius, S.
dc.contributor.author Yusuf, S.
dc.date.accessioned 2020-06-10T18:12:14Z
dc.date.available 2020-06-10T18:12:14Z
dc.date.issued 2014
dc.identifier.uri https://hdl.handle.net/20.500.12866/8068
dc.description.abstract BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after non-cardiac 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 arrest. en_US
dc.language.iso eng
dc.publisher Massachusetts Medical Society
dc.relation.ispartofseries New England Journal of Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Female en_US
dc.subject Humans en_US
dc.subject Male en_US
dc.subject Aged en_US
dc.subject Middle Aged en_US
dc.subject Treatment Failure en_US
dc.subject human en_US
dc.subject aged en_US
dc.subject female en_US
dc.subject male en_US
dc.subject incidence en_US
dc.subject risk assessment en_US
dc.subject priority journal en_US
dc.subject treatment outcome en_US
dc.subject controlled study en_US
dc.subject major clinical study en_US
dc.subject article en_US
dc.subject death en_US
dc.subject drug effect en_US
dc.subject drug efficacy en_US
dc.subject placebo en_US
dc.subject Kaplan-Meier Estimate en_US
dc.subject multicenter study en_US
dc.subject surgery en_US
dc.subject drug safety en_US
dc.subject randomized controlled trial en_US
dc.subject risk reduction en_US
dc.subject heart infarction en_US
dc.subject Myocardial Infarction en_US
dc.subject high risk patient en_US
dc.subject dose response en_US
dc.subject hypotension en_US
dc.subject Postoperative Complications en_US
dc.subject hazard ratio en_US
dc.subject acetylsalicylic acid en_US
dc.subject treatment duration en_US
dc.subject bradycardia en_US
dc.subject length of stay en_US
dc.subject factorial design en_US
dc.subject low drug dose en_US
dc.subject Surgical Procedures, Operative en_US
dc.subject Adrenergic alpha-2 Receptor Agonists en_US
dc.subject clonidine en_US
dc.subject Clonidine en_US
dc.subject heart arrest en_US
dc.subject Hypotension en_US
dc.subject noncardiac surgery en_US
dc.subject Perioperative Care en_US
dc.subject perioperative period en_US
dc.subject preoperative treatment en_US
dc.title Clonidine in patients undergoing noncardiac surgery en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1056/NEJMoa1401106
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn 1533-4406


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