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To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Intensive Care VHN.
Linköping University, Department of Medical and Health Sciences, Anesthesiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Anaesthesiology and Surgery UHL.
Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
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2010 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 104, no 3, 305-312 p.Article in journal (Refereed) Published
Abstract [en]

Background: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding.

Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery.

Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups.

Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications.

 

Place, publisher, year, edition, pages
2010. Vol. 104, no 3, 305-312 p.
Keyword [en]
analgesics non-opioid, aspirin; complications, haemorrhage; heart, ischaemia; surgery, non-cardiac
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-20759DOI: 10.1093/bja/aeq003ISI: 000274485900006OAI: oai:DiVA.org:liu-20759DiVA: diva2:235827
Note
This is a pre-copy-editing, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The definitive publisher-authenticated version: Anna Oscarsson Tibblin, Anil Gupta, Mats Fredrikson, Johannes Järhult, Matti Nyström, Eva Pettersson, Bijan Darvish, Helena Krook, Eva Swahn and Christina Eintrei, To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial, 2010, British Journal of Anaesthesia, (104), 3, 305-312. is available online at: http://dx.doi.org/doi:10.1093/bja/aeq003 Copyright: Oxford University Press http://www.oxfordjournals.org/ Available from: 2009-09-18 Created: 2009-09-18 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Perioperative myocardial damage and cardiac outcome in patients-at-risk undergoing non-cardiac surgery
Open this publication in new window or tab >>Perioperative myocardial damage and cardiac outcome in patients-at-risk undergoing non-cardiac surgery
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite increasingly sophisticated perioperative management, cardiovascular complications continue to be major challenges for the clinician. As a growing number of elderly patients with known coronary artery disease (CAD) or with risk factors for CAD are undergoing non-cardiac surgery, cardiovascular complications will remain a significant clinical problem in the future.

The overall objective of this thesis was to study the incidence of myocardial damage and perioperative adverse cardiac events, to determine predictors of poor outcome and to assess the effect of a medical intervention in patients at risk undergoing non-cardiac surgery.

The studies in this thesis were conducted on a total of 952 patients undergoing non-cardiac surgery. Studies I and IV were multicenter studies; whereas the patients included in studies II and III underwent non-cardiac surgery at Linkoping University Hospital, Sweden.

The correlation between postoperative myocardial damage and short- and long-term outcome were studied in 546 patients, aged 70 years or older undergoing non-cardiac surgery of at least 30 minutes duration. This study showed a close correlation between postoperative myocardial damage and poor short- as well as long-term outcome. Elevated Troponin T was a strong independent predictor of mortality within one year of surgery. In 186 patients with ASA physical status classification III or IV undergoing non-elective surgery, the incidence of myocardial damage was 33%. In this study preoperative myocardial damage was an independent predictor of major adverse cardiac events in the postoperative period. In 69 patients with ASA physical status classification III & IV undergoing acute hip surgery, we found a close correlation between elevated NT-proBNP value prior to surgery and cardiac complications in the postoperative period. To study the effect of acetylsalicylic acid on postoperative myocardial damage and cardiovascular events, 220 patients at risk were randomized to receive 75 mg of acetylsalicylic acid or placebo 7 days prior to surgery until the third postoperative day. This study showed that treatment with acetylsalicylic acid resulted in an 8% (95% CI 1-15%) absolute risk reduction of having a postoperative major adverse cardiac event. No statistically significant differences of bleeding complications were seen between the groups.

In conclusion, this thesis contributes to the understanding of the clinical relevance of elevated cardiac markers (with or without clinical or ECG signs of myocardial damage) in patients undergoing elective or emergency surgery. Moreover, we have identified predictors of poor outcome in the perioperative period that could be used as tools for identifying patients at risk. Finally, we have shown that continuing acetylsalicylic acid in the perioperative period reduced the risk of major adverse cardiac events within 30 days of surgery.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 89 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1141
Keyword
Myocardial damage, cardiac complication, outcome, aspirin, acetylsalicylic acid
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:liu:diva-20240 (URN)978-91-7393-572-2 (ISBN)
Public defence
2009-10-02, Victoriasalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
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Supervisors
Available from: 2009-09-18 Created: 2009-08-31 Last updated: 2012-05-09Bibliographically approved

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Oscarsson Tibblin, AnnaGupta, AnilFredrikson, MatsJärhult, JohannesNyström, MattiPettersson, EvaSwahn, EvaEintrei, Christina

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