Paul S Myles1, Julian A Smith2, Jessica Kasza3, Brendan Silbert4, Mohandas Jayarajah5, Thomas Painter6, D James Cooper7, Silvana Marasco7, John McNeil3, Jean S Bussières8, Shay McGuinness9, Matthew T V Chan10, Sophie Wallace7, Andrew Forbes3. 1. Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia. Electronic address: p.myles@alfred.org.au. 2. Monash University, Melbourne, Australia; Monash Medical Centre, Clayton, Australia. 3. Monash University, Melbourne, Australia. 4. St Vincent's Hospital, Fitzroy, Australia. 5. South West Cardiac Centre, Derriford Hospital, Plymouth, United Kingdom. 6. Royal Adelaide Hospital and Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia. 7. Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia. 8. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Quebec, Canada. 9. Auckland City Hospital, Auckland, New Zealand. 10. The Chinese University of Hong Kong, Hong Kong, China.
Abstract
BACKGROUND:Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receiveaspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. RESULTS: Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). CONCLUSIONS: In patients undergoing coronary artery surgery, preoperativeaspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
RCT Entities:
BACKGROUND:Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. METHODS: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. RESULTS:Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). CONCLUSIONS: In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
Authors: Patrizia Natale; Suetonia C Palmer; Valeria M Saglimbene; Marinella Ruospo; Mona Razavian; Jonathan C Craig; Meg J Jardine; Angela C Webster; Giovanni Fm Strippoli Journal: Cochrane Database Syst Rev Date: 2022-02-28
Authors: Fiona Nemeh; Rachelle Buchbinder; Carmel M Hawley; Mark R Nelson; Jacqui G Waterkeyn; Christopher M Reid Journal: Trials Date: 2022-01-28 Impact factor: 2.279
Authors: Ar K Aung; Robert Pickles; Anne Knight; Leigh-Anne Shannon; Andrew Bowers; Sinead Donnelly; Douglas F Johnson; Ian A Scott; Elizabeth L Potter Journal: Intern Med J Date: 2022-08-10 Impact factor: 2.611