To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial

Abstract

In high-risk patients undergoing non-cardiac surgery, perioperative aspirin reduced the risk of MACE without increasing bleeding complications. However, the study was not powered to evaluate bleeding complications.

Endoscopy in patients on antiplatelet or anticoagulant therapy, including direct oral anticoagulants: British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE) guidelines

“…34 35 In an RCT of 220 patients on low-dose aspirin for secondary prevention undergoing noncardiac surgery, patients were randomised to continuation or temporary replacement of aspirin by placebo (-7 to +3 days after surgery). 36 Major cardiac events occurred within 30 days in 1.8% of the aspirin group compared to 9% in the placebo group ( p=0.02). No difference in bleeding complications was seen between the two groups.…”

“…106 107 Caution is required if aspirin therapy is interrupted when prescribed for secondary prophylaxis due to the high risk of thrombotic events. [34][35][36] The association of thienopyridene or aspirin use with the risk of post-ESD bleeding has been examined in several studies of gastric ESD. These studies are, however, retrospective single-centre case studies with a variety of APAs, and differences in regimens for discontinuing or continuing therapy.…”

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

“…A randomized trial investigated the impact of the perioperative management of APT, showing a reduction in thrombotic cardiovascular events in the group receiving aspiring. In contrast, no significant differences were found for perioperative hemorrhagic events [17]. In terms of patients with stents, a study published in 2000 reported on a cohort of patients undergoing emergency surgery in the weeks following the positioning of a bare-metal stent.…”

Prevention, epidemiology, and prognosis of perioperative ­myocardial injury

“…RCTs showed mixed results but with a potential decreased risk of vascular events in patients on ASA in the perioperative period [46][47][48]. In contrast, the PEP trial, involving 13 356 patients undergoing hip surgery, demonstrated more cardiac ischaemic events (death due to ischaemic heart disease or nonfatal MI) in patients randomised to ASA versus placebo (HR 1.33, 95% CI 1.00-1.78) [49].…”