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Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery.
Graham, Michelle M; Sessler, Daniel I; Parlow, Joel L; Biccard, Bruce M; Guyatt, Gordon; Leslie, Kate; Chan, Matthew T V; Meyhoff, Christian S; Xavier, Denis; Sigamani, Alben; Kumar, Priya A; Mrkobrada, Marko; Cook, Deborah J; Tandon, Vikas; Alvarez-Garcia, Jesus; Villar, Juan Carlos; Painter, Thomas W; Landoni, Giovanni; Fleischmann, Edith; Lamy, Andre; Whitlock, Richard; Le Manach, Yannick; Aphang-Lam, Meylin; Cata, Juan P; Gao, Peggy; Terblanche, Nicolaas C S; Ramana, Pamidimukkala V; Jamieson, Kim A; Bessissow, Amal; Mendoza, Gabriela R; Ramirez, Silvia; Diemunsch, Pierre A; Yusuf, Salim; Devereaux, P J.
  • Graham MM; University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada (M.M.G.).
  • Sessler DI; Cleveland Clinic, Cleveland, Ohio (D.I.S.).
  • Parlow JL; Queen's University, Kingston, Ontario, Canada (J.L.P.).
  • Biccard BM; Groote Schuur Hospital and University of Cape Town, Western Cape, South Africa (B.M.B.).
  • Guyatt G; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Leslie K; Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, and Monash University, Melbourne, Victoria, Australia (K.L.).
  • Chan MTV; The Chinese University of Hong Kong, Hong Kong, China (M.T.C.).
  • Meyhoff CS; Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark (C.S.M.).
  • Xavier D; St. John's Medical College and Research Institute, Bangalore, India (D.X.).
  • Sigamani A; Narayana Hrudayalaya, Bangalore, India (A.S.).
  • Kumar PA; University of North Carolina, Chapel Hill, North Carolina (P.A.K.).
  • Mrkobrada M; Schulich School of Medicine & Dentistry at Western University, London, Ontario, Canada (M.M.).
  • Cook DJ; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Tandon V; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Alvarez-Garcia J; Sant Pau Hospital and Biomedical Research Institute, Autonomous University of Barcelona, Research Center of Cardiovascular Diseases (CIBERCV), Barcelona, Spain (J.A.).
  • Villar JC; Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia, and Department of Medicine, Universidad Autónoma de Bucaramanga, Santander, Colombia (J.C.V.).
  • Painter TW; University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia (T.W.P.).
  • Landoni G; IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy (G.L.).
  • Fleischmann E; Medical University of Vienna, Vienna, Austria (E.F.).
  • Lamy A; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Whitlock R; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Le Manach Y; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Aphang-Lam M; Hospital Arzobispo Loayza, Universidad Peruana Cayetano Heredia, Lima, Peru (M.A.).
  • Cata JP; The University of Texas MD Anderson Cancer Center, Houston, Texas (J.P.C.).
  • Gao P; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Terblanche NCS; Royal Hobart Hospital and University of Tasmania, Hobart, Tasmania, Australia (N.C.T.).
  • Ramana PV; CARE Hospitals, Maharanipeta, Visakhapatnam, India (P.V.R.).
  • Jamieson KA; Auckland City Hospital, Auckland, New Zealand (K.A.J.).
  • Bessissow A; McGill University Health Centre, Montréal, Québec, Canada (A.B.).
  • Mendoza GR; Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (G.R.M.).
  • Ramirez S; Hospital Universitario Fundación Hospital Alcorcon, Madrid, Spain (S.R.).
  • Diemunsch PA; Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France (P.A.D.).
  • Yusuf S; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
  • Devereaux PJ; Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada (G.G., D.J.C., V.T., A.L., R.W., Y.L., P.G., S.Y., P.D.).
Ann Intern Med ; 168(4): 237-244, 2018 02 20.
Article en En | MEDLINE | ID: mdl-29132159
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. Primary Funding Source Canadian Institutes of Health Research.
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Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Operativos / Inhibidores de Agregación Plaquetaria / Aspirina / Intervención Coronaria Percutánea Tipo de estudio: Clinical_trials Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2018 Tipo del documento: Article
Texto completo
Imprimir
XML
PubMed Links
Search on Google

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Procedimientos Quirúrgicos Operativos / Inhibidores de Agregación Plaquetaria / Aspirina / Intervención Coronaria Percutánea Tipo de estudio: Clinical_trials Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Año: 2018 Tipo del documento: Article