Stopping vs. continuing aspirin before coronary artery surgery

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dc.contributor.authorMyles, P.
dc.contributor.authorSmith, J.
dc.contributor.authorForbes, A.
dc.contributor.authorSilbert, B.
dc.contributor.authorJayarajah, M.
dc.contributor.authorPainter, T.
dc.contributor.authorCooper, D.
dc.contributor.authorMarasco, S.
dc.contributor.authorMcNeil, J.
dc.contributor.authorBussières, J.
dc.contributor.authorWallace, S.
dc.date.issued2016
dc.description.abstractBACKGROUND Most patients with coronary artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing surgery, but it is unclear whether aspirin should be stopped before coronary artery surgery. METHODS We used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo coronary artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. RESULTS Among 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo. A primary outcome event occurred in 202 patients in the aspirin group (19.3%) and in 215 patients in the placebo group (20.4%) (relative risk, 0.94; 95% confidence interval, 0.80 to 1.12; P = 0.55). Major hemorrhage leading to reoperation occurred in 1.8% of patients in the aspirin group and in 2.1% of patients in the placebo group (P = 0.75), and cardiac tamponade occurred at rates of 1.1% and 0.4%, respectively (P = 0.08). CONCLUSIONS Among patients undergoing coronary artery surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo. (Funded by the Australian National Health and Medical Research Council and others; Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639.)
dc.description.statementofresponsibilityPaul S. Myles, Julian A. Smith, Andrew Forbes, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John McNeil, Jean S. Bussières, and Sophie Wallace, for the ATACAS Investigators of the ANZCA Clinical Trials Network
dc.identifier.citationNew England Journal of Medicine, 2016; 374(8):728-737
dc.identifier.doi10.1056/NEJMoa1507688
dc.identifier.issn0028-4793
dc.identifier.issn1533-4406
dc.identifier.orcidPainter, T. [0000-0003-2216-2046]
dc.identifier.urihttp://hdl.handle.net/2440/99232
dc.language.isoen
dc.publisherMassachusetts Medical Society
dc.relation.grantNHMRC
dc.rightsCopyright © 2016 Massachusetts Medical Society. All rights reserved.
dc.source.urihttps://doi.org/10.1056/nejmoa1507688
dc.subjectATACAS Investigators of the ANZCA Clinical Trials Network
dc.titleStopping vs. continuing aspirin before coronary artery surgery
dc.typeJournal article
pubs.publication-statusPublished

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