HealthDay News – Preoperative aspirin does not lower risk of death or thrombotic complications among patients undergoing coronary artery surgery, according to research published in the February 25 issue of the New England Journal of Medicine.

Paul S. Myles, MD, MPH, of Monash University in Melbourne, Australia, and colleagues used a 2-by-2 factorial design to randomly assign patients who were undergoing coronary artery surgery, and who were at risk for perioperative complications, to receive aspirin 100 mg or placebo. In the other component of the trial, patients were randomly assigned to receive tranexamic acid or placebo. The primary outcome was a composite of death and thrombotic events, including nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, and bowel infarction.

Researchers noted that in the aspirin component of the clinical trial, 1047 patients received aspirin and 1053 patients received placebo. A primary outcome event of death or thrombotic complication occurred in 19.3% of patients in the aspirin group and 20.4% of those in the placebo group (relative risk: 0.94; 95% confidence interval: 0.80-1.12; P=.55). The adverse effect of major hemorrhage leading to reoperation occurred in 1.8% of patients in the aspirin group and 2.1% of those in the placebo group (P=.75); cardiac tamponade occurred in 1.1% and 0.4%, respectively (P=.08).


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“Among patients undergoing coronary artery surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo,” the authors wrote.

Disclosures: Bayer Pharma, which supplied the aspirin and matched placebo tablets, partially funded the study.

Reference

Myles PS, Smith JA, Forbes A, et al; for the ATACAS Investigators of the ANZCA Clinical Trials Network. Stopping vs continuing aspirin before coronary artery surgery. N Engl J Med. 2016;374:728-737, doi: 10.1056/NEJMoa1507688.