McMaster University

McMaster University

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McMaster researcher tops most-cited list

By Laura Thompson
Published: March 20, 2009
P.J. Devereaux
Dr. P.J. Devereaux, an assistant professor in the Department of Clinical Epidemiology and Biostatistics

First, a McMaster University study discovered beta-blockers can increase the risk of certain cardiac complications around the time of surgery. Now the study has become one of the most-cited findings in its discipline.

The research, published in the prestigious medical journal The Lancet in May 2008, has been identified as a fast breaking paper in field of clinical medicine by Thomson Reuters’ Essential Science Indicators. The co-principal investigator of the study was Dr. P.J. Devereaux, an assistant professor in the Department of Clinical Epidemiology and Biostatistics with a joint appointment in the Department of Medicine.

The POISE study, the world’s largest randomized controlled trial of its kind, evaluated the effectiveness of beta-blockers compared to placebo around the time of surgery. Beta-blockers are commonly given to treat high blood pressure. For more than a decade, guidelines have recommended giving beta-blockers to patients undergoing surgery, except for operations on the heart.

POISE found that beta-blockers given around the time surgery decrease the risk of a heart attack, but increase the risk of major stroke or death.

That is, for every 1,000 patients who receive a beta-blocker around the time of surgery, the medication would prevent 15 patients from having a heart attack. However, eight patients would die and five patients would have a stroke.

"If the results of POISE are widely applicable, throughout the last decade 800,000 patients would have died prematurely and 500,000 patients would have suffered a stroke because they were given a beta-blocker around the time of surgery," Devereaux said in a recent interview with ScienceWatch.com.

"This highlights the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, the importance and need for large randomized trials in the surgical setting and the risk in guidelines making recommendations based on weak evidence," he told the website, which tracks trends and performance in research.

McMaster researchers have now initiated the POISE-2 pilot and are hoping to move ahead with the POISE-2 trial, which will evaluate clonidine, a medication that works in much the same way as a beta-blocker, but may have less significant reductions in blood pressure.

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