| Title: |
Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery |
| Authors: |
Graham, MM; Sessler, DI; Parlow, JL; Biccard, BM; Guyatt, G; Leslie, K; Chan, MTV; Meyhoff, CS; Xavier, D; Sigamani, A; Kumar, PA; Mrkobrada, M; Cook, DJ; Tandon, V; Alvarez-Garcia, J; Villar, JC; Painter, TW; Landoni, G; Fleischmann, E; Lamy, A; Whitlock, R; Le Manach, Y; Aphang-Lam, M; Cata, JP; Gao, P; Nicolaas Terblanche; Ramana, PV; Jamieson, KA; Bessissow, A; Mendoza, GR; Ramirez, S; Diemunsch, PA; Yusuf, S; Devereaux, PJ |
| Publication Year: |
2018 |
| Subject Terms: |
Epidemiology not elsewhere classified; percutaneous intervention; aspirin; myocardial infarct; non-cardiac surgery |
| Description: |
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: ... |
| Document Type: |
article in journal/newspaper |
| Language: |
unknown |
| Relation: |
102.100.100/556622; https://figshare.com/articles/journal_contribution/Aspirin_in_patients_with_previous_percutaneous_coronary_intervention_undergoing_noncardiac_surgery/22987643 |
| Availability: |
https://figshare.com/articles/journal_contribution/Aspirin_in_patients_with_previous_percutaneous_coronary_intervention_undergoing_noncardiac_surgery/22987643 |
| Rights: |
In Copyright |
| Accession Number: |
edsbas.57210FEB |
| Database: |
BASE |