Effect of aspirin in vascular surgery in patients from a randomized clinical trial (POISE-2)

Abstract

This study suggests that the overall POISE-2 results apply to vascular surgery. Perioperative withdrawal of chronic aspirin therapy did not increase cardiovascular or vascular occlusive complications. Registration number: NCT01082874 ( http://www.clinicaltrials.gov).

Perioperative Anemia Management

“…In a subgroup of 603 who underwent vascular surgery, there was similarly no change in the primary end point (p ¼ 0.29). However, patients continued on aspirin over the perioperative period showed an increase in bleeding (HR: 1.23; 95% CI: 1.01-1.49; p ¼ 0.04) without any benefit on patient outcomes, 54 demonstrating that discontinuation of aspirin is safe, even in those at a high vascular risk.…”

“…Patients were randomized to receive either aspirin, or placebo and clonidine, or placebo. 54 More than 10,000 patients were enrolled. There was no difference in the primary outcome of MI, which was observed in 13.7% in the aspirin group and 9% in the placebo group (hazard ratio [HR]: 1.48; 95% CI: 0.71-3.09) in those with aneurysmal repair.…”

2019 Update in perioperative cardiovascular medicine

“…Whether perioperative aspirin is benefi cial in other subgroups was unknown. Biccard et al 7 investigated the effect of perioperative aspirin in the subgroup of patients from the POISE-2 trial who underwent vascular surgery. The primary outcome was death or MI within 30 days.…”

“…Aspirin had little effect ( Table 2). 7 Limitations. There were few adverse events, and this substudy was underpowered for the primary and secondary outcomes.…”

Evolution of Clinical Thinking and Practice Regarding Aspirin: What Has Changed and Why?

“…No difference in 30-day perioperative death or MI was found between groups, but bleeding, mostly at the surgical site and not lethal, was higher with ASA use. 35,36 However, many of the POISE-2 trial patients had low vascular risk, with fewer than 5% of patients having previous coronary stent implantation. Furthermore, many patients were administered perioperative thromboprophylaxis with an anticoagulant in the trial.…”