Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery

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

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