The Role of β-Blockers in Cardiac Perioperative Management

Sezai, Akira; Shiono, Motomi

doi:10.5761/atcs.ed.13-00374

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…1) POAF is the most common complication following cardiac surgery, with an incidence of 16%-85%. 7,8) Stroke is the most important clinical outcome of POAF. It also significantly affects the prognosis.…”

Section: Introductionmentioning

confidence: 99%

A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation

Sezai

Taoka

Osaka

et al. 2021

ATCS

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Purpose: Recently, guidelines recommended the use of direct oral anticoagulants (DOACs) for the management of non-valvular atrial fibrillation (NVAF). Postoperative atrial fibrillation (POAF) is the most common post-surgical complication of cardiac surgery, but the efficacy and safety of DOAC for POAF have rarely been investigated. We conducted a prospective observational study to investigate the efficacy and safety of DOAC administered immediately after POAF. Materials and Methods: In all, 135 patients that experienced POAF after cardiac surgery were treated with a DOAC. Primary endpoints were either bleeding or thromboembolic events. Secondary endpoints included changes in hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and pleural/pericardial effusion. Results: Patients were treated with apixaban (n = 31), edoxaban (n = 87), and rivaroxaban (n = 17). Major bleeding (p = 0.011) and gastrointestinal (GI) bleeding (p = 0.047) were significantly more frequent in the rivaroxaban group. Stroke was observed in one rivaroxaban group patient and none in the other two groups. Conclusion: DOAC as anticoagulation therapy for the early intervention of POAF following cardiac surgery is associated with a low incidence of major bleeding; a favorable safety profile and excellent efficacy were demonstrated for DOAC. Furthermore, our results indicate that the safety and efficacy of apixaban and edoxaban are better than rivaroxaban.

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Section: Introductionmentioning

confidence: 99%

A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation

Sezai

Taoka

Osaka

et al. 2021

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“…4,5) It is reported that these agents indicated as class I use in CABG operations cause ED. 6,7) It is observed that the third-generation beta-blocker agent nebivolol which has a high b 1 -adrenoceptor selectivity leads directly to arterial and venous vasodilatation by nitric oxide (NO) system activation.…”

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confidence: 99%

The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery

Gür

Gürkan

Yümün

et al. 2017

ATCS

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IntroductionErectile dysfunction (ED) is defined as the inability to achieve or maintain an erectile function sufficient for satisfactory sexual performance. 1) Today, it is reported that the most common etiology for ED is organic disorders accompanying with vascular diseases and several studies suggest that there is a strong relationship between cardiovascular risk factors and ED. 2,3) Ischemic cardiac diseases The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass SurgeryÖzcan Gür, MD, 1 Selami Gurkan, MD, 1 Gunduz Yumun, MD, 1 and Polat Turker, MD 2Purpose: Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. Methods: In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. Results: No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was %85.96 in Group 1, %83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). Conclusion: Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.

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“…Various factors have been reported as causes of POAF, 31,32 and there are some reports that β-blockers are effective for preventing POAF after cardiovascular surgery. 33,34 Furthermore, the presence of high HbA1c levels (i.e., >7% or >8.6% 35) ) and/or hyperglycemia after cardiac surgery has been shown to be associated with POAF. 36) We observed no association between POAF and HbA1c values, possibly because HbA1c levels were relatively low (<7%) in our study population.…”

Section: Discussionmentioning

confidence: 99%

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Sato

Hosojima

Ishikawa

et al. 2017

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Purpose: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. Methods: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. Results: Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. Conclusion: Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.

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The Role of β-Blockers in Cardiac Perioperative Management

Cited by 13 publications

References 24 publications

A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation

A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation

The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

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