Aspirin During Noncardiac Surgery: Only in Patients with Prior Angioplasty

A new analysis from the POISE-2 study suggests that aspirin should not be withheld prior to noncardiac surgery in patients with a history of coronary angioplasty, even if their coronary procedure occurred several years earlier.

AAS durante cirugías no cardíacas: solamente en pacientes con angioplastia previa

Patients with a history of coronary angioplasty who need cardiac surgery are more likely to benefit from continued aspirin therapy, thus avoiding thrombosis, instead of being harmed by the risk for bleeding. This is a post-hoc analysis of the original study, which means that the outcomes are hypothesis-generating conclusions (that are as interesting as always).


Read also: Endovascular Strategy Seems Superior against Surgery in Ruptured Aneurysms”.


The original POISE-2 study was conducted at 135 centers in 35 countries, and it randomized 10,010 patients who required noncardiac surgery to perioperative aspirin or placebo. The trial found no difference between groups as regards death or infarction at 30 days, but did see an increased risk of bleeding in the aspirin group.

 

The current analysis, which was not prespecified in the original study, focused on the 470 randomized patients who had previously undergone coronary angioplasty.

 

Patients who had received a drug-eluting stent within 1 year and a bare-metal stent within 6 weeks before the procedure were excluded from the analysis due to already existing evidence in favor of continuing aspirin administration.


Read also: Closure of Patent Foramen Ovale for the Treatment of Migraine”.


The mean time from angioplasty to surgery was 64 months (5.3 years) and most patients had received a bare-metal stent.

 

As opposed to what was seen for the overall trial, patients with prior angioplasty derived significant benefit from aspirin, as it reduced the risk of death and infarction at 30 days (6% vs. 11.4%; hazard ratio [HR]: 0.5). Such difference was basically driven by infarction, since the risk for mortality and, also importantly, the risk for bleeding were similar among groups.


Read also: TAVR in Pure Aortic Regurgitation: New Devices, New Outcomes”.


An additional analysis on prior coronary disease per se was negative. Only prior stent angioplasty would warrant continuing aspirin therapy.

 

Original title: Aspirin in Patients with Previous Percutaneous Coronary Intervention (PCI) Undergoing Noncardiac Surgery: The POISE-2 PCI Substudy.

Reference: Graham MM et al. American Heart Association 2017 Scientific Sessions.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...