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The POISE (PeriOperative ISchaemic Evaluation) trial published in The Lancet in 2008 suggested high dose peri-operative metoprolol in patients at high risk of atherosclerotic disease undergoing non-cardiac surgery reduces cardiac deaths but increases overall all cause deaths and strokes.

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Perioperative extended release metoprolol in patients with or at high risk of atherosclerotic disease undergoing non-cardiac surgery will reduce risk of major cardiovascular events.

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Patients >45yrs age, non-cardiac surgery expected LOS >24hrs, with any of: CAD; PVD; CVA; admission for CCF in last 3yrs; major vascular surgery (except AVF, vein stripping, CEA), or 3 of: intrathoracic or intraperitoneal surgery; Hx CCF;TIA;diabetes;creatinine >175umol/L;age>70yrs,emergent or urgent surgery.

Randomised to placebo or metoprolol.

100mg ER metoprolol 2-4 hrs before surgery. Another 100mg within 6hrs
postop if BP >100mmHg and HR >80, otherwise at 12hrs. Then 200mg daily 30 days. If NBM IVI (15mg over 60min).

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8351 pts

Cardiac death - Placebo 6.9% vs Metoprolol 5.8%

MI - Placebo 5.7% vs Metoprolol 4.2%

CVA - Placebo 0.5% vs Metoprolol 1%

Death - Placebo 2.3% vs Metoprolol 3.1%

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Was the dose of metoprolol too high?

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