Aspirin in patients undergoing noncardiac surgery

Garg, A.X.; Sigamani, A.; Pogue, J.; Alonso-Coello, P.; Forget, P.; Mizera, R.; Baigent, C.; Rodseth, R.N.; Robinson, A.; VanHelder, T.; Eikelboom, J.; Torres, D.; Whitlock, R.; Málaga Rodríguez, Germán Javier; Parlow, J.L.; Berwanger, O.; Pasin, L.; Le Manach, Y.; Devereaux, P.J.; Meyhoff, C.S.; Biccard, B.M.; Xavier, D.; Fleischmann, E.; Pettit, S.; Tiboni, M.; Gao, P.; Guyatt, G.; Chan, M.T.V.; Wang, C.Y.; Lurati Buse, G.; Chow, C.; Kearon, C.; Cook, D.; Leslie, K.; Chrolavicius, S.; Kumar, P.A.; Yusuf, S.; Villar, J.C.; Paniagua, P.; Mrkobrada, M.; Botto, F.; Graham, M.; Amir, M.; Lamy, A.; Srinathan, S.; Sessler, D.I.; Kurz, A.

dc.contributor.author	Devereaux, P.J.
dc.contributor.author	Mrkobrada, M.
dc.contributor.author	Sessler, D.I.
dc.contributor.author	Leslie, K.
dc.contributor.author	Alonso-Coello, P.
dc.contributor.author	Kurz, A.
dc.contributor.author	Villar, J.C.
dc.contributor.author	Sigamani, A.
dc.contributor.author	Biccard, B.M.
dc.contributor.author	Meyhoff, C.S.
dc.contributor.author	Parlow, J.L.
dc.contributor.author	Guyatt, G.
dc.contributor.author	Robinson, A.
dc.contributor.author	Garg, A.X.
dc.contributor.author	Rodseth, R.N.
dc.contributor.author	Botto, F.
dc.contributor.author	Lurati Buse, G.
dc.contributor.author	Xavier, D.
dc.contributor.author	Chan, M.T.V.
dc.contributor.author	Tiboni, M.
dc.contributor.author	Cook, D.
dc.contributor.author	Kumar, P.A.
dc.contributor.author	Forget, P.
dc.contributor.author	Málaga Rodríguez, Germán Javier
dc.contributor.author	Fleischmann, E.
dc.contributor.author	Amir, M.
dc.contributor.author	Eikelboom, J.
dc.contributor.author	Mizera, R.
dc.contributor.author	Torres, D.
dc.contributor.author	Wang, C.Y.
dc.contributor.author	VanHelder, T.
dc.contributor.author	Paniagua, P.
dc.contributor.author	Berwanger, O.
dc.contributor.author	Srinathan, S.
dc.contributor.author	Graham, M.
dc.contributor.author	Pasin, L.
dc.contributor.author	Le Manach, Y.
dc.contributor.author	Gao, P.
dc.contributor.author	Pogue, J.
dc.contributor.author	Whitlock, R.
dc.contributor.author	Lamy, A.
dc.contributor.author	Kearon, C.
dc.contributor.author	Baigent, C.
dc.contributor.author	Chow, C.
dc.contributor.author	Pettit, S.
dc.contributor.author	Chrolavicius, S.
dc.contributor.author	Yusuf, S.
dc.date.accessioned	2020-06-10T18:12:14Z
dc.date.available	2020-06-10T18:12:14Z
dc.date.issued	2014
dc.identifier.uri	https://hdl.handle.net/20.500.12866/8067
dc.description.abstract	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.	en_US
dc.language.iso	eng
dc.publisher	Massachusetts Medical Society
dc.relation.ispartofseries	New England Journal of Medicine
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.rights.uri	https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject	Female	en_US
dc.subject	Humans	en_US
dc.subject	Male	en_US
dc.subject	Aged	en_US
dc.subject	Middle Aged	en_US
dc.subject	Treatment Failure	en_US
dc.subject	human	en_US
dc.subject	aged	en_US
dc.subject	female	en_US
dc.subject	male	en_US
dc.subject	risk assessment	en_US
dc.subject	priority journal	en_US
dc.subject	follow up	en_US
dc.subject	controlled study	en_US
dc.subject	major clinical study	en_US
dc.subject	outcome assessment	en_US
dc.subject	article	en_US
dc.subject	death	en_US
dc.subject	drug effect	en_US
dc.subject	placebo	en_US
dc.subject	Kaplan-Meier Estimate	en_US
dc.subject	multicenter study	en_US
dc.subject	drug withdrawal	en_US
dc.subject	randomized controlled trial	en_US
dc.subject	hospitalization	en_US
dc.subject	patient care	en_US
dc.subject	heart infarction	en_US
dc.subject	Myocardial Infarction	en_US
dc.subject	Postoperative Complications	en_US
dc.subject	postoperative period	en_US
dc.subject	hazard ratio	en_US
dc.subject	acetylsalicylic acid	en_US
dc.subject	treatment duration	en_US
dc.subject	bleeding	en_US
dc.subject	length of stay	en_US
dc.subject	factorial design	en_US
dc.subject	low drug dose	en_US
dc.subject	Surgical Procedures, Operative	en_US
dc.subject	clonidine	en_US
dc.subject	noncardiac surgery	en_US
dc.subject	Perioperative Care	en_US
dc.subject	perioperative period	en_US
dc.subject	preoperative treatment	en_US
dc.subject	Aspirin	en_US
dc.subject	Platelet Aggregation Inhibitors	en_US
dc.subject	Postoperative Hemorrhage	en_US
dc.title	Aspirin in patients undergoing noncardiac surgery	en_US
dc.type	info:eu-repo/semantics/article
dc.identifier.doi	https://doi.org/10.1056/NEJMoa1401105
dc.subject.ocde	https://purl.org/pe-repo/ocde/ford#3.02.00
dc.relation.issn	1533-4406