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Combination Therapy


The treatment of coronary disease and angina relies on multimodal therapy. There are no prospective trials documenting multiple therapies in non-cardiac surgery. Two publications have compared the additive effects of beta-blockers and lipid lowering agents. Both publications showed that the effect of single therapy was dependant on the preoperative risk. Neither found an appreciable effect in the low risk population; in fact there was a suggestion of increased side effects in this group. Essentially, there is little or no benefit in patients with a preoperative RCRI score of 1. However, in those with a RCRI of 3, the reduction in risk by a single agent is approximately 50%. The addition of a second agent further reduces risk another 50% in the high-risk patients. The concept of multiple drug therapy [utilizing separate classes of drugs] in high risk populations requires more investigation.

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