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Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery

Citation

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 Statement

Copyright 2018 American College of Physicians

DOI: doi:10.7326/M17-2341

Abstract

Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery.

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 Details

Item Type:Refereed Article
Keywords:percutaneous intervention, aspirin, myocardial infarct, non-cardiac surgery
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Terblanche, NCS (Dr Nico Terblanche)
ID Code:138398
Year Published:2018
Web of Science® Times Cited:37
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-04-06
Last Modified:2020-06-25
Downloads:0

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