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Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery

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dc.contributor.author Graham, Michelle M.
dc.contributor.author Sessler, Daniel I.
dc.contributor.author Parlow, Joel L.
dc.contributor.author Biccard, Bruce M.
dc.contributor.author Guyatt, Gordon
dc.contributor.author Leslie, Kate
dc.contributor.author Chan, Matthew T. V.
dc.contributor.author Meyhoff, Christian S.
dc.contributor.author Xavier, Denis
dc.contributor.author Sigamani, Alben
dc.contributor.author Kumar, Priya A.
dc.contributor.author Mrkobrada, Marko
dc.contributor.author Cook, Deborah J.
dc.contributor.author Tandon, Vikas
dc.contributor.author Alvarez-Garcia, Jesus
dc.contributor.author Villar, Juan Carlos
dc.contributor.author Painter, Thomas W.
dc.contributor.author Landoni, Giovanni
dc.contributor.author Fleischmann, Edith
dc.contributor.author Lamy, Andre
dc.contributor.author Whitlock, Richard
dc.contributor.author Le Manach, Yannick
dc.contributor.author Aphang-Lam, Meylin
dc.contributor.author Cata, Juan P.
dc.contributor.author Gao, Peggy
dc.contributor.author Terblanche, Nicolaas C. S.
dc.contributor.author Ramana, Pamidimukkala V.
dc.contributor.author Jamieson, Kim A.
dc.contributor.author Bessissow, Amal
dc.contributor.author Mendoza, Gabriela R.
dc.contributor.author Ramirez, Silvia
dc.contributor.author Diemunsch, Pierre A.
dc.contributor.author Yusuf, Salim
dc.contributor.author Devereaux, P. J.
dc.date.accessioned 2018-11-30T02:09:29Z
dc.date.available 2018-11-30T02:09:29Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4003
dc.description.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. en_US
dc.language.iso eng
dc.publisher American College of Physicians
dc.relation.ispartofseries Annals of Internal Medicine
dc.rights info:eu-repo/semantics/restrictedAccess
dc.subject Absolute risk reduction en_US
dc.subject Aspirin en_US
dc.subject Drugs en_US
dc.subject Hazard ratio en_US
dc.subject Hemorrhage en_US
dc.subject Hospital medicine en_US
dc.subject Myocardial infarction en_US
dc.subject Percutaneous coronary intervention en_US
dc.subject Stent implantation en_US
dc.subject Surgery en_US
dc.title Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7326/M17-2341
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.27
dc.relation.issn 1539-3704


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