Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Pleth Variability Index in Orthopedic Surgery: Comment

    Research output: Contribution to journalComment/debateResearchpeer-review

  2. Perioperative Opioid Administration: A Critical Review of Opioid-free versus Opioid-sparing Approaches

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Of Railroads and Roller Coasters: Considerations for Perioperative Blood Pressure Management?

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Dexamethasone Dose and Early Postoperative Recovery after Mastectomy: A Double-blind, Randomized Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Continuous peripheral perfusion index in patients admitted to hospital wards - An observational study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Preoperative anaesthesia triage with a patient-centred system-A prospective clinical study

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Physiological abnormalities in patients admitted with acute exacerbation of COPD: an observational study with continuous monitoring

    Research output: Contribution to journalJournal articleResearchpeer-review

  • Perioperative Ischemic Evaluation-2 Trial (POISE-2) Investigators
View graph of relations

BACKGROUND: The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown.

METHODS: The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h.

RESULTS: Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1).

CONCLUSIONS: Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect.

Original languageEnglish
JournalAnesthesiology
Volume132
Issue number4
Pages (from-to)692-701
Number of pages10
ISSN0003-3022
DOIs
Publication statusPublished - Apr 2020

    Research areas

  • Aged, Analgesics/administration & dosage, Anti-Inflammatory Agents, Non-Steroidal/administration & dosage, Aspirin/administration & dosage, Clonidine/administration & dosage, Female, Follow-Up Studies, Humans, Internationality, Male, Middle Aged, Myocardial Infarction/diagnosis, Perioperative Care/adverse effects, Postoperative Complications/diagnosis, Time Factors

ID: 62356369