Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery
| Autor: | Yannick Le Manach, Bruce M Biccard, Alben Sigamani, Salim Yusuf, Matthew T. V. Chan, Thomas Painter, Philip J. Devereaux, Vikas Tandon, Joel L. Parlow, Juan P. Cata, Amal Bessissow, Kate Leslie, Edith Fleischmann, Andre Lamy, Gabriela R. Mendoza, Christian S. Meyhoff, Marko Mrkobrada, Jesús Álvarez-García, Peggy Gao, Kim A. Jamieson, Meylin Aphang-Lam, Daniel I. Sessler, Michelle M. Graham, Pierre Diemunsch, Giovanni Landoni, Juan Carlos Villar, Silvia Ramirez, Priya A. Kumar, Richard P. Whitlock, Gordon H. Guyatt, Nicolaas C.S. Terblanche, Pamidimukkala V. Ramana, Deborah J. Cook, Denis Xavier |
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| Přispěvatelé: | Graham, Michelle M, Sessler, Daniel I, Parlow, Joel L, Biccard, Bruce M, Guyatt, Gordon, Leslie, Kate, Chan, Matthew T. V, Meyhoff, Christian S, Xavier, Deni, Sigamani, Alben, Kumar, Priya A, Mrkobrada, Marko, Cook, Deborah J, Tandon, Vika, Alvarez-Garcia, Jesu, Villar, Juan Carlo, 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. |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_treatment Myocardial Infarction 030204 cardiovascular system & hematology law.invention Percutaneous coronary intervention 0302 clinical medicine Postoperative Complications Randomized controlled trial law 030212 general & internal medicine Myocardial infarction Hospital medicine Stent implantation Aspirin Drugs General Medicine Middle Aged 3. Good health medicine.anatomical_structure Treatment Outcome Surgical Procedures Operative cardiovascular system Platelet aggregation inhibitor purl.org/pe-repo/ocde/ford#3.02.27 [https] Drug Therapy Combination Female medicine.drug medicine.medical_specialty Hazard ratio Hemorrhage Clonidine Drug Administration Schedule 03 medical and health sciences Percutaneous Coronary Intervention Multicenter trial Absolute risk reduction Internal Medicine medicine Humans cardiovascular diseases Antihypertensive Agents Aged business.industry medicine.disease Surgery Coronary arteries Conventional PCI business Biomarkers Platelet Aggregation Inhibitors |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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