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Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

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  • Michelle M Graham
  • Daniel I Sessler
  • Joel L Parlow
  • Bruce M Biccard
  • Gordon Guyatt
  • Kate Leslie
  • Matthew T V Chan
  • Christian S Meyhoff
  • Denis Xavier
  • Alben Sigamani
  • Priya A Kumar
  • Marko Mrkobrada
  • Deborah J Cook
  • Vikas Tandon
  • Jesus Alvarez-Garcia
  • Juan Carlos Villar
  • Thomas W Painter
  • Giovanni Landoni
  • Edith Fleischmann
  • Andre Lamy
  • Richard Whitlock
  • Yannick Le Manach
  • Meylin Aphang-Lam
  • Juan P Cata
  • Peggy Gao
  • Nicolaas C S Terblanche
  • Pamidimukkala V Ramana
  • Kim A Jamieson
  • Amal Bessissow
  • Gabriela R Mendoza
  • Silvia Ramirez
  • Pierre A Diemunsch
  • Salim Yusuf
  • P J Devereaux
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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.

Primary Funding Source: Canadian Institutes of Health Research.

Original languageEnglish
JournalAnnals of Internal Medicine
Volume168
Issue number4
Pages (from-to)237–244
ISSN0003-4819
DOIs
Publication statusPublished - 2018

    Research areas

  • Journal Article

ID: 52690272