Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial.
Aged
Antifibrinolytic Agents
/ administration & dosage
Aspirin
/ administration & dosage
Coronary Artery Bypass
/ adverse effects
Coronary Artery Disease
/ diagnostic imaging
Coronary Thrombosis
/ etiology
Disability Evaluation
Double-Blind Method
Female
Fibrinolytic Agents
/ administration & dosage
Hemorrhage
/ chemically induced
Humans
Male
Middle Aged
Myocardial Infarction
/ etiology
Progression-Free Survival
Risk Factors
Time Factors
Tranexamic Acid
/ administration & dosage
anesthesia
antiplatelet
disability-free survival
major adverse cardiac events
outcome
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
16
04
2018
revised:
07
07
2018
accepted:
21
08
2018
pubmed:
8
11
2018
medline:
25
2
2020
entrez:
8
11
2018
Statut:
ppublish
Résumé
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. 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. 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). In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
Sections du résumé
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.
Identifiants
pubmed: 30401528
pii: S0022-5223(18)32509-1
doi: 10.1016/j.jtcvs.2018.08.114
pii:
doi:
Substances chimiques
Antifibrinolytic Agents
0
Fibrinolytic Agents
0
Tranexamic Acid
6T84R30KC1
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
633-640Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.