Search

Purpose Recent Aspirin trials have questioned its role in traditional coronary disease, even in high risk cohorts. Data is conflicting for the use of aspirin in preventing development of CAV. Transplant CAV remains a significant cause of mortality and morbidity. Risk factors for CAV include ischemic indication for transplantation as well as traditional cardiovascular risk factors. Mammalian target of rapamycin (mTOR) inhibitors may be protective. Methods We retrospectively analysed 205 patients who underwent transplant from 2013-2016 at two Australian transplant centers (St Vincent's Hospital, Sydney and The Alfred Hospital, Melbourne). Patients were categorized into those commenced on aspirin (100mg/day) during their transplant admission and those who were not. The primary outcome was moderate-severe CAV (International Society for Heart and Lung Transplantation classification), determined by surveillance coronary angiography (CA) or computed tomography CA. Results A total of 205 patients (89 aspirin, 116 no aspirin) were included. 5 cases of moderate-severe CAV (1 aspirin, 4 no aspirin) were confirmed over a mean follow-up of 3.6 years. Event-free survival was 99% in those exposed to aspirin, compared with 97% without aspirin(p=0.28). There was no significant difference in baseline demographics or metabolic risk factors. Calcineurin inhibitor use was significantly less in the aspirin group (70% vs 87%, p=0.004), whilst mTOR inhibitor use was increased in the aspirin group (58%vs38%, p=0.002). Conclusion Over a 3.5 year follow-up, there was only a non-significant trend towards reduced moderate-severe CAV when exposed to aspirin despite higher mTOR use in this group. This study demonstrated the need for further long term follow up of this cohort to determine if aspirin is associated with a significant reduction in the rate of late CAV development. [ABSTRACT FROM AUTHOR]