Home > Journal Club > Journal Club 5 November 2014

Journal Club 5 November 2014

Paper

Aspirin in Patients Undergoing Noncardiac Surgery

Presenter

SH

Summary

Background

There is substantial variability in the perioperative administration of aspirin in
patients undergoing noncardiac surgery, both among patients who are already on
an aspirin regimen and among those who are not.

Methods

Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were
preparing to undergo noncardiac surgery and were at risk for vascular complications
to receive aspirin or placebo and clonidine or placebo. The results of the aspirin
trial are reported here. The patients were stratified according to whether they
had not been taking aspirin before the study (initiation stratum, with 5628 patients)
or they were already on an aspirin regimen (continuation stratum, with 4382 patients).
Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery
and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and
for 7 days in the continuation stratum, after which patients resumed their regular
aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial
infarction at 30 days.

Results

The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group
and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin
group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P = 0.92). Major bleeding was
more common in the aspirin group than in the placebo group (230 patients [4.6%]
vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P = 0.04). The primary
and secondary outcome results were similar in the two aspirin strata.

Conclusions

Administration of aspirin before surgery and throughout the early postsurgical
period had no significant effect on the rate of a composite of death or nonfatal
myocardial infarction but increased the risk of major bleeding. (Funded by the
Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials

Supplementary Material

This was assessed as important paper. The following supplementary material is provided

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