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VOLUME 8 , ISSUE 1 ( June, 2018 ) > List of Articles


Angiotensin-converting Enzyme Inhibitors taken on Day of Total Joint Replacement are associated with Adverse Outcomes: A Randomized Controlled Trial

Cynthia L Green, Daniel Mangiapani, Sawley Wilde, Tyler Vovos, Kevin McCoy, Jennifer Friend, Samuel Wellman, Michael Bolognesi

Keywords : Angiotensin-converting enzyme inhibitors, Postoperative hypotension, Randomized clinical trial, Total joint arthroplasty.

Citation Information : Green CL, Mangiapani D, Wilde S, Vovos T, McCoy K, Friend J, Wellman S, Bolognesi M. Angiotensin-converting Enzyme Inhibitors taken on Day of Total Joint Replacement are associated with Adverse Outcomes: A Randomized Controlled Trial. The Duke Orthop J 2018; 8 (1):33-36.

DOI: 10.5005/jp-journals-10017-1092

License: CC BY-NC 3.0

Published Online: 01-05-2017

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Angiotensin-converting enzyme inhibitors (ACEIs) are among the most frequently prescribed medications used to treat hypertension and are commonplace among patients undergoing elective total hip and knee arthroplasty. It is the purpose of this study to evaluate the perioperative effects of ACE-Is in an elective total hip and knee arthroplasty patient group. Materials and methods: A total of 46 patients were randomized to one of two study arms: An ACE-I cessation arm, who were instructed to stop their ACE-I 2 days prior to surgery (last dose >48 hours prior to surgery), and an ACE-I continuation arm, who continued their ACE-I prior to surgery. Results: Despite being underpowered to detect a significant difference between cessation and continuation arms of the study, the continuation arm had more intraoperative hypotension (61 vs 39%, p = 0.140), more intraoperative vasopressors (83 vs 61%, p = 0.102), more postoperative hypotension (13 vs 9%, p = 1.000), and more acute kidney injury (AKI) (22 vs 14%, p = 0.700). Further, a patient in the continuation arm sustained severe intraoperative hypotension and required escalation of care. Conclusion: The results of this randomized controlled trial did not reach statistical significance, but showed a clear trend toward worse outcomes in total joint arthroplasty patients who continued ACE-Is through the perioperative period.

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