Clinical outcomes associated with per-operative discontinuation of aspirin in patients with coronary artery disease: A systematic review and meta-analysis.

BACKGROUND: Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin. METHODS: Multiple databases were searched from inception of these databases until March 2015 to identify studies that reported discontinuation of aspirin in patients undergoing surgery. The outcomes measured were all cause mortality, nonfatal myocardial infarction and other relevant thrombotic events (MACE) which also may include, fatal and nonfatal MI, stent thrombosis and restenosis, stroke, perioperative cardiovascular complications (heart failure, MI, VTE, acute stroke) and perioperative bleeding during the perioperative period to up to 30 days after surgery. RESULTS: A total of 1,018 titles were screened, after which six observational studies met the inclusion criteria. Our analysis suggests that there is no difference in MACE with planned discontinuation of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I2 = 55%). Early discontinuation of aspirin showed a decreased risk of peri-operative bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I2 = 42%). CONCLUSION: Our analysis suggests that planned short-term discontinuation in the appropriate clinical setting appears to be safe in the correct clinical setting with no increased risk of thrombotic events and with a decreased risk of bleeding. © 2016 Wiley Periodicals, Inc.

Risk of Ischemic Heart Disease in Patients With Sjögren's Syndrome.

BACKGROUND: Ischemic heart disease (IHD) has emerged as a major cause of morbidity and mortality in patients with autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis, but the risk of IHD in Sjögren's syndrome (SjS) is unknown. To fill this knowledge gap, we estimated the prevalence and risk of IHD with SjS compared to controls from the general population using the Healthcare Cost and Utilization Project National Inpatient Sample 2011 database. MATERIALS AND METHODS: The Healthcare Cost and Utilization Project administrative longitudinal database contains encounter-level information on inpatient stays, emergency department visits and ambulatory surgery in all U.S. hospitals. We conducted a cross-sectional study among the inpatient population diagnosed with SjS and matched 1:4 with controls for age, sex and hospital region. Odds ratio for IHD was calculated as cases compared to controls. The contribution of various risk factors to IHD was also evaluated by logistic regression. RESULTS: Analysis demonstrated that 7,154 of 13,086 cases (54.7%) of SjS had IHD compared to 27,367 of 52,448 controls (52.2%). The adjusted odds ratio for IHD in those with SjS was 0.898 (95% CI: 0.844-0.955). Patients with SjS were significantly more likely to have hypertension, diabetes, apnea and lipid disorders. CONCLUSIONS: To our knowledge, this is the largest population-based study investigating the risk of IHD in patients with SjS. We found a modest, though statistically significant, decrease in the risk of IHD in SjS compared to controls.

Absence of insulin-induced vasodilation of internal carotid artery in type 2 diabetes.

BACKGROUND: Impaired cerebrovascular reserve could contribute to the increased risk of strokes in type 2 diabetes. We have shown a vasodilatory effect of insulin on the internal carotid artery in healthy subjects. As absence of this effect could be responsible for the impairment of cerebral blood flow reserve demonstrated in this population, we have now investigated the effect of insulin on the internal carotid artery of type 2 diabetics. METHODS: Internal carotid artery diameter was continuously monitored, using a 7.5-MHz transducer linked to an Acuson XP10 ultrasonograph, during the infusion of 125 mL of 10% dextrose with 3 units of regular insulin and 5 mmol of potassium chloride, over 1 h. RESULTS: The internal carotid artery diameter increased progressively from 5.4 +/- 1 to 6 +/- 1 mm at 60 min in controls (p < 0.05), an increase of 10% over baseline, while there was no dilatation in type 2 diabetes group; 6.6 +/- 1 mm at baseline and at 60 min. The response in type 2 diabetics was significantly impaired compared to controls. Glucose levels were maintained at 114-131 mg/dL in type 2 diabetics and at 73-124 mg/dL in controls. There was no change in MABP or heart rate during the infusion. CONCLUSIONS: We conclude that insulin-induced dilation of internal carotid artery is absent in type 2 diabetes and that lack of this beneficial effect may contribute to the increased risk and the mortality and morbidity associated with stroke in this population.