Aspirin in Patients Undergoing Noncardiac Surgery

Abstract

Administration of aspirin before surgery and throughout the early postsurgical period had no significant effect on the rate of a composite of death or nonfatal myocardial infarction but increased the risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; POISE-2 ClinicalTrials.gov number, NCT01082874.).

Does the use of statins improve outcomes in coronary artery bypass graft surgery?

“…[11] Randomized trial evidence supports a reduction in periprocedural MI with statin administration even when commenced 24 h before percutaneous David R. McIlroy coronary intervention. [13] However, extrapolating findings from nonsurgical studies to the operative setting may not be appropriate, [14,15] and although statins are generally well tolerated and safe, they do have well-documented adverse effects that may be amplified in elderly patients receiving multiple medications. [16] This highlights the importance of evaluating the evidence for statin therapy within the context of cardiac surgery rather than relying on indirect evidence or hypothetical benefits to guide practice.…”

What is the optimal perioperative management of antiplatelet therapy?

“…Devereaux et al 2 conducted a randomized, controlled trial of 10,010 patients undergoing noncardiac surgery. Patients were randomized to aspirin or placebo.…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…122 The patients were stratified according to whether they had not been taking aspirin before the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). In the POISE-2 trial, aspirin was stopped at least three days (but usually seven days) before surgery.…”