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Título:
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Aspirin in patients with previous percutaneous coronary intervention undergoing noncardiac surgery
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Autores:
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Graham, Michelle M. ;
Sessler, Daniel I. ;
Parlow, Joel L. ;
Biccard, Bruce M. ;
Guyatt, Gordon ;
Leslie, Kate ;
Chan, Matthew T. V. ;
Meyhoff, Christian S. ;
Xavier, Denis ;
Sigamani, Alben ;
Kumar, Priya A. ;
Mrkobrada, Marko ;
Cook, Deborah J. ;
Tandon, Vikas ;
Alvarez-Garcia, Jesus ;
Villar, Juan Carlos ;
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.
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Tipo de documento:
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texto impreso
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Editorial:
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American College of Physicians, 2018-11-30T02:09:29Z
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Nota general:
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info:eu-repo/semantics/restrictedAccess
https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
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Idiomas:
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Inglés
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Palabras clave:
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Editados por otras instituciones
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Artículos
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Artículos en revistas indizadas
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Resumen:
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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.
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En línea:
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http://doi.org/10.7326/M17-2341
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