Perioperative discontinuation of renin–angiotensin system inhibitors in non-cardiac surgery: is it time to change what we tell our patients?
Bibliographic record
Abstract
How should recommendations regarding perioperative discontinuation vs continuation of renin-angiotensin system inhibitors (RASIs), in patients undergoing non-cardiac surgery, change, consistently with the change in evidence? The 2022 European Society of Cardiology guidelines suggested that withholding RASIs on the day of surgery may be considered to prevent perioperative hypotension, mainly based on observational studies and small randomized controlled trials (RCTs) showing an association between discontinuation of RASIs and lower risk of perioperative hypotension. New evidence coming from large international RCTs has confirmed that the perioperative discontinuation compared with continuation of RASIs leads to a reduction of perioperative hypotension but limited to intraoperative hypotension, with no effect on post-operative hypotension (which is what likely drives clinical outcomes); moreover, new RCTs have demonstrated no effect on patient-important outcomes. Rather than strengthening the recommendation in favour of perioperative discontinuation of RASIs only based on the effect on intraoperative hypotension (surrogate outcome), this new trial evidence support that both strategies are viable options, if there are awareness of the risk of intraoperative hypotension and tools to monitor and counteract it in the operating room. A RASI discontinuation strategy could be the appropriate choice in situations with increased risk of more severe intraoperative hypotension (e.g., patient has an unusually low pre-operative blood pressure, or surgery is one typically associated with large blood loss).
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.058 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.004 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.009 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".