AI Article Synopsis
- This study examines the effects of aspirin on patients who have had prior percutaneous coronary intervention (PCI) and are undergoing noncardiac surgery, as there is uncertainty regarding aspirin's role in this context.
- A subgroup analysis of a multicenter trial involving nearly 5000 patients found that aspirin significantly reduced the risk of death or nonfatal heart attacks in those with prior PCI, with an absolute risk reduction of 5.5%.
- However, the impact of aspirin on major bleeding events in this group was unclear, suggesting that while aspirin may provide cardiovascular protection, it could also carry bleeding risks that need further investigation.
Article 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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.7326/M17-2341 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Swab Testing to Optimize Pneumonia treatment with empiric Vancomycin (STOP-Vanc): study protocol for a randomized controlled trial.
Trials
December 2024
Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
Background: Vancomycin, an antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA), is frequently included in empiric treatment for community-acquired pneumonia (CAP) despite the fact that MRSA is rarely implicated in CAP. Conducting polymerase chain reaction (PCR) testing on nasal swabs to identify the presence of MRSA colonization has been proposed as an antimicrobial stewardship intervention to reduce the use of vancomycin. Observational studies have shown reductions in vancomycin use after implementation of MRSA colonization testing, and this approach has been adopted by CAP guidelines.
View Article and Find Full Text PDFA randomized trial of low-dose thrombolysis, ultrasound-assisted thrombolysis, or heparin for intermediate-high risk pulmonary embolism-the STRATIFY trial: design and statistical analysis plan.
Trials
December 2024
Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Background: Intermediate-high risk pulmonary embolism (PE) carries a significant risk of hemodynamic deterioration or death. Treatment should balance efficacy in reducing clot burden with the risk of complications, particularly bleeding. Previous studies on high-dose, short-term thrombolysis with alteplase (rtPA) showed a reduced risk of hemodynamic deterioration but no change in mortality and increased bleeding complications.
View Article and Find Full Text PDFComparative analysis of arterial involvement in predominant cranial and isolated extracranial phenotypes of giant cell arteritis using F-FDG PET-CT.
Arthritis Res Ther
December 2024
Department of Rheumatology, Hospital Universitario de Bellvitge. Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
Objective: To investigate differences in arterial involvement patterns on F-FDG PET-CT between predominant cranial and isolated extracranial phenotypes of giant cell arteritis (GCA).
Methods: A retrospective review of F-FDG PET-CT findings was conducted on 140 patients with confirmed GCA. The patients were divided into two groups: the cranial group, which presented craniofacial ischemic symptoms either at diagnosis or during follow-up, and the isolated extracranial group which never exhibited such manifestations.
Exploring key embryonic developmental morphokinetic parameters that affect clinical outcomes during the PGT cycle using time-lapse monitoring systems.
BMC Pregnancy Childbirth
December 2024
Reproductive Medical Center, Henan Province Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, No. 1 East Jianshe Road, Erqi District, Zhengzhou, China.
Research Question: Is it possible to predict blastocyst quality, embryo chromosomal ploidy, and clinical pregnancy outcome after single embryo transfer from embryo developmental morphokinetic parameters?
Design: The morphokinetic parameters of 1011 blastocysts from 227 patients undergoing preimplantation genetic testing were examined. Correlations between the morphokinetic parameters and the quality of blastocysts, chromosomal ploidy, and clinical pregnancy outcomes following the transfer of single blastocysts were retrospectively analyzed.
Results: The morphokinetic parameters of embryos in the high-quality blastocyst group were significantly shorter than those in the low-quality blastocyst group (p < 0.
Comparison of clinical characteristics and outcomes in candidaemia patients with and without COVID-19: a multicentre retrospective study.
BMC Infect Dis
December 2024
Department of Infectious Disease, Department of Internal Medicine, Chonnam National University Medical School, 42, Jebong Ro, Donggu, Gwangju, 61469, South Korea.
Background: Invasive fungal infections have been reported as complications with significant mortality and morbidity in patients hospitalized with COVID-19. This study aimed to evaluate the clinical characteristics and outcomes of candidaemia patients with COVID-19 and to investigate the association between COVID-19 and mortality in candidaemia patients.
Methods: This retrospective study included candidaemia patients aged 18 years or older admitted to four university-affiliated tertiary hospitals in South Korea between January 1, 2020, and December 31, 2022.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!