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Start Over Author "Terblanche, Nicolaas C S" Topic surgical procedures, operative
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1. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery.

Author

Graham MM, Sessler DI, Parlow JL, Biccard BM, Guyatt G, Leslie K, Chan MTV, Meyhoff CS, Xavier D, Sigamani A, Kumar PA, Mrkobrada M, Cook DJ, Tandon V, Alvarez-Garcia J, Villar JC, Painter TW, Landoni G, Fleischmann E, Lamy A, Whitlock R, Le Manach Y, Aphang-Lam M, Cata JP, Gao P, Terblanche NCS, Ramana PV, Jamieson KA, Bessissow A, Mendoza GR, Ramirez S, Diemunsch PA, Yusuf S, and Devereaux PJ

Subjects
Aged, Antihypertensive Agents therapeutic use, Aspirin adverse effects, Biomarkers blood, Clonidine therapeutic use, Drug Administration Schedule, Drug Therapy, Combination, Female, Hemorrhage chemically induced, Humans, Male, Middle Aged, Myocardial Infarction prevention & control, Platelet Aggregation Inhibitors adverse effects, Postoperative Complications chemically induced, Postoperative Complications prevention & control, Treatment Outcome, Aspirin therapeutic use, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors therapeutic use, Surgical Procedures, Operative
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.

Published
2018
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2. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

Author

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, 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, and Devereaux, P. J.

Subjects
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
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.

Published
2018

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