Graham, MM and Sessler, DI and Parlow, JL and Biccard, BM and Guyatt, G and Leslie, K and Chan, MTV and Meyhoff, CS and Xavier, D and Sigamani, A and Kumar, PA and Mrkobrada, M and Cook, DJ and Tandon, V and Alvarez-Garcia, J and Villar, JC and Painter, TW and Landoni, G and Fleischmann, E and Lamy, A and Whitlock, R and Le Manach, Y and Aphang-Lam, M and Cata, JP and Gao, P and Terblanche, NCS and Ramana, PV and Jamieson, KA and Bessissow, A and Mendoza, GR and Ramirez, S and Diemunsch, PA and Yusuf, S and Devereaux, PJ, Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery, Annals of Internal Medicine, 168, (4) pp. 237-244. ISSN 0003-4819 (2018) [Refereed Article]
Copyright 2018 American College of Physicians
Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI.
Design: Nonprespecified subgroup analysis of a multicenter factorial trial. Computerized Internet randomization was done between 2010 and 2013. Patients, clinicians, data collectors, and outcome adjudicators were blinded to treatment assignment. (ClinicalTrials.gov: NCT01082874).
Setting: 135 centers in 23 countries.
Patients: Adults aged 45 years or older who had or were at risk for atherosclerotic disease and were having noncardiac surgery. Exclusions were placement of a bare-metal stent within 6 weeks, placement of a drug-eluting stent within 1 year, or receipt of nonstudy aspirin within 72 hours before surgery.
Intervention: Aspirin therapy (overall trial, n = 4998; subgroup, n = 234) or placebo (overall trial, n = 5012; subgroup, n = 236) initiated within 4 hours before surgery and continued throughout the perioperative period. Of the 470 subgroup patients, 99.9% completed follow-up.
Measurements: The 30-day primary outcome was death or nonfatal myocardial infarction; bleeding was a secondary outcome.
Results: In patients with prior PCI, aspirin reduced the risk for the primary outcome (absolute risk reduction, 5.5% [95% CI, 0.4% to 10.5%]; hazard ratio [HR], 0.50 [CI, 0.26 to 0.95]; P for interaction = 0.036) and for myocardial infarction (absolute risk reduction, 5.9% [CI, 1.0% to 10.8%]; HR, 0.44 [CI, 0.22 to 0.87]; P for interaction = 0.021). The effect on the composite of major and life-threatening bleeding in patients with prior PCI was uncertain (absolute risk increase, 1.3% [CI, -2.6% to 5.2%]). In the overall population, aspirin increased the risk for major bleeding (absolute risk increase, 0.8% [CI, 0.1% to 1.6%]; HR, 1.22 [CI, 1.01 to 1.48]; P for interaction = 0.50).
Limitation: Nonprespecified subgroup analysis with small sample.
Conclusion: Perioperative aspirin may be more likely to benefit rather than harm patients with prior PCI.
|Item Type:||Refereed Article|
|Keywords:||percutaneous intervention, aspirin, myocardial infarct, non-cardiac surgery|
|Research Division:||Health Sciences|
|Research Field:||Epidemiology not elsewhere classified|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Terblanche, NCS (Dr Nico Terblanche)|
|Web of Science® Times Cited:||37|
|Deposited By:||Menzies Institute for Medical Research|
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