Preoperative statin therapy for patients undergoing cardiac surgery

Liakopoulos, Oliver J.; Kuhn, Elmar; Slottosch, Ingo; Wassmer, Gernot; Wahlers, Thorsten

doi:10.1002/14651858.cd008493

Cited by 11 publications

(22 citation statements)

References 55 publications

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“…Preoperative medications have also been extensively evaluated as both risk and protective factors for a variety of postoperative complications. Several retrospective studies exploring any association between the preoperative use of statins and postoperative AKI have given conflicting results 62–64 . In a recent retrospective study of 98,939 patients undergoing major surgery the preoperative use of statins was associated with a 20%–26% reduction in the incidence of AKI as defined by consensus criteria 65 .…”

Section: Risk Factorsmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Hobson

Ruchi

2017

Critical Care Clinics

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Synopsis Acute kidney injury (AKI) is a common complication in the surgical patient and is associated with increases in mortality, an increased risk for chronic kidney disease (CKD) and hemodialysis after discharge, and increased cost. Better understanding of the risk factors that contribute to perioperative AKI has led to improved AKI prediction and will eventually lead to improved prevention of AKI, mitigation of injury when AKI occurs and enhanced recovery in patients who sustain AKI. The development of advanced clinical prediction scores for AKI, new imaging techniques and novel biomarkers for early detection of AKI provides new tools toward these ends.

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Section: Risk Factorsmentioning

confidence: 99%

Perioperative Acute Kidney Injury

Hobson

Ruchi

2017

Critical Care Clinics

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“…The data on preoperative statin use and risk for AKI is evolving and contradictory. The subgroup analysis of a systematic review of preoperative use of statins among cardiac surgery patients (including four studies with a total of 367 patients, including 19 patients with renal failure) demonstrated no benefit from preoperative statin use [58]. A study from The Cleveland Clinic reporting no difference in AKI or hospital mortality between 4,683 statin users propensity matched with 22,000 non-statin users was limited to elective surgery cases and reported a very low incidence of AKI (6%), hospital mortality (0.6%), and need for dialysis (0.05%) rendering it difficult to compare to other studies.…”

Section: Risk Factors For Akimentioning

confidence: 99%

“…A study from The Cleveland Clinic reporting no difference in AKI or hospital mortality between 4,683 statin users propensity matched with 22,000 non-statin users was limited to elective surgery cases and reported a very low incidence of AKI (6%), hospital mortality (0.6%), and need for dialysis (0.05%) rendering it difficult to compare to other studies. In a small cohort of 151 vascular surgery patients, Kor et al found no difference with preoperative statin use using moderate to severe AKI (incidence 7%), need for RRT (3%) and mortality (5%) as endpoints [58, 59]. In contrast a population-based Canadian retrospective cohort study including 213,347 older patients who underwent major elective surgery demonstrated a 16% lower odds of severe AKI, 17% lower odds of acute dialysis and 21% lower odds of mortality for patients on a preoperative statin [60].…”

Section: Risk Factors For Akimentioning

confidence: 99%

Acute Kidney Injury in the Surgical Patient

Hobson

Singhania

Bïhorac

2015

Critical Care Clinics

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Synopsis Perioperative acute kidney injury (AKI) is a common, morbid and costly surgical complication. Current efforts to understand and manage AKI in surgical patients focus on prevention, mitigation of further injury when AKI has occurred, treatment of associated conditions and facilitation of renal recovery. Lesser severity AKI is now understood to be much more common, and more morbid, than was previously believed. The ability to detect AKI within hours of onset would be helpful in protecting the kidney and in preserving renal function, and several imaging and biomarker modalities are currently being evaluated. Automated, rapid and noninvasive collection and analysis of preoperative and operating room data raises the prospect of real time risk prediction for perioperative AKI. Prevention of AKI is of paramount importance, and goal-directed fluid management, remote ischemic preconditioning and early involvement of a nephrologist have all been shown to be effective.

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“…29 Beta-blockers carry a Class I, Level B recommendation for reducing the incidence of AF; amiodarone is considered second tier therapy. Metoprolol, sotalol, magnesium, amiodarone, statins, atrial pacing and posterior pericardiotomy all reduce AF rates, 24, 27 with a non-significant trend toward reduction in stroke rates. 27 …”

Section: Introductionmentioning

confidence: 97%

“…2 The Multicenter Study of Perioperative Ischemia found a 50% reduction in perioperative stroke (1.3% vs 2.6%, P = 0.01) if aspirin was administered within 48 hours of revascularization. 22 Recent meta-analysis 23 of preoperative statin therapy trials found that statin use in CABG (or CABG plus Valve) surgery reduces post-operative atrial fibrillation (AF), shortens hospital stay, and contrary to a smaller 2012 meta-analysis, 24 reduces stroke and mortality. Furthermore, there is concern that statin withdrawal after cardiac surgery may be injurious.…”

Section: Introductionmentioning

confidence: 99%

Neurological complications of cardiac surgery

McDonagh¹,

Berger²,

Mathew³

et al. 2014

The Lancet Neurology

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The consultant neurologist is frequently called upon to assess patients with neurologic complications from cardiac surgery. Some complications mandate acute intervention while others require longer term observation and management. The body of literature pertaining to these complications is massive and ever-changing. Similarly, technological advancements in surgical intervention and modifications in surgical technique create new avenues for neurologic injury. Rapid precise neurologic assessment is paramount and rests on a solid understanding of the evidence base and procedural variables. This clinically focused review is intended to describe the current state of the field for the consultant neurologist.

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Preoperative statin therapy for patients undergoing cardiac surgery

Cited by 11 publications

References 55 publications

Perioperative Acute Kidney Injury

Perioperative Acute Kidney Injury

Acute Kidney Injury in the Surgical Patient

Neurological complications of cardiac surgery

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