Aspirin in Patients Undergoing Noncardiac Surgery

被引：631

作者：

Devereaux, P. J. ^{[1
,2
,3
]}

Mrkobrada, M. ^{[1
,7
]}

Sessler, D. I. ^{[13
]}

Leslie, K. ^{[14
]}

Alonso-Coello, P. ^{[15
]}

Kurz, A. ^{[13
]}

Villar, J. C. ^{[17
,18
]}

Sigamani, A. ^{[19
]}

Biccard, B. M. ^{[20
]}

Meyhoff, C. S. ^{[21
]}

Parlow, J. L. ^{[8
,9
]}

Guyatt, G. ^{[2
,3
]}

Robinson, A. ^{[1
]}

Garg, A. X. ^{[10
]}

Rodseth, R. N. ^{[20
]}

Botto, F. ^{[1
,22
]}

Buse, G. Lurati ^{[1
,23
]}

Xavier, D. ^{[19
]}

Chan, M. T. V. ^{[24
]}

Tiboni, M. ^{[3
]}

Cook, D. ^{[2
,3
]}

Kumar, P. A. ^{[25
]}

Forget, P. ^{[26
]}

Malaga, G. ^{[27
]}

Fleischmann, E. ^{[28
]}

Amir, M. ^{[29
]}

Eikelboom, J. ^{[1
,2
,3
]}

Mizera, R. ^{[3
]}

Torres, D. ^{[30
]}

Wang, C. Y. ^{[31
]}

VanHelder, T. ^{[4
]}

Paniagua, P. ^{[16
]}

Berwanger, O. ^{[32
]}

Srinathan, S. ^{[11
]}

Graham, M. ^{[12
]}

Pasin, L. ^{[33
]}

Le Manach, Y. ^{[1
,2
,4
]}

Gao, P. ^{[1
]}

Pogue, J. ^{[1
,2
]}

Whitlock, R. ^{[1
,5
,6
]}

Lamy, A. ^{[1
,5
]}

Kearon, C. ^{[2
,3
]}

Baigent, C. ^{[34
,35
]}

Chow, C. ^{[36
,37
]}

Pettit, S. ^{[1
]}

Chrolavicius, S. ^{[1
]}

Yusuf, S. ^{[1
,2
,3
]}

机构：

[1] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON L8S 4L8, Canada

[2] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[3] McMaster Univ, Dept Med, Hamilton, ON, Canada

[4] McMaster Univ, Dept Anesthesia, Hamilton, ON, Canada

[5] McMaster Univ, Dept Surg, Hamilton, ON L8S 4L8, Canada

[6] McMaster Univ, Dept Crit Care, Hamilton, ON L8S 4L8, Canada

[7] London Hlth Sci Ctr, Dept Med, London, ON, Canada

[8] Kingston Gen Hosp, Dept Anesthesiol & Perioperat Med, Kingston, ON K7L 2V7, Canada

[9] Queens Univ, Kingston, ON, Canada

[10] Univ Western Ontario, Dept Med, Div Nephrol, London, ON, Canada

[11] Univ Manitoba, Dept Surg, Winnipeg, MB R3T 2N2, Canada

[12] Univ Alberta, Dept Med, Edmonton, AB, Canada

[13] Cleveland Clin, Dept Outcomes Res, Inst Anesthesiol, Cleveland, Qld, Australia

[14] Royal Melbourne Hosp, Dept Anaesthesia & Pain Management, Melbourne, Vic, Australia

[15] Biomed Res Inst, Iberoamer Cochrane Ctr, Barcelona, Spain

[16] Biomed Res Inst, Dept Anesthesiol, Barcelona, Spain

[17] Univ Autonoma Bucaramanga, Bogota, Colombia

[18] Fdn Cardioinfantil, Bogota, Colombia

[19] St Johns Natl Acad Hlth Sci, Dept Pharmacol, Div Clin Res & Training, Bangalore, Karnataka, India

[20] Univ KwaZulu Natal, Dept Anaesthet, Perioperat Res Grp, Nelson R Mandela Sch Med, Durban, South Africa

[21] Univ Copenhagen, Herlev Hosp, Dept Anesthesiol, DK-2730 Herlev, Denmark

[22] Inst Cardiovasc Buenos Aires, Estudios Clin Latino Amer, Buenos Aires, DF, Argentina

[23] Univ Basel Hosp, Dept Anesthesia, CH-4031 Basel, Switzerland

[24] Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Hong Kong, Peoples R China

[25] Univ N Carolina, Dept Anesthesiol, Chapel Hill, NC USA

[26] Clin Univ St Luc, Brussels, Belgium

[27] Univ Peruana Cayetano Heredia, Lima, Peru

[28] Med Univ Vienna, Dept Anesthesia & Intens Care, Vienna, Austria

[29] Shifa Int Hosp, Dept Surg, Islamabad, Pakistan

[30] Clin Santa Maria, Dept Anesthesiol, Santiago, Chile

[31] Univ Malaya, Dept Anesthesiol, Kuala Lumpur, Malaysia

[32] Hosp Coracao, Res Inst HCor, Sao Paulo, Brazil

[33] Ist Sci San Raffaele, I-20132 Milan, Italy

[34] Univ Oxford, Clin Trial Serv Unit, Oxford, England

[35] Univ Oxford, Epidemiol Studies Unit, Oxford, England

[36] George Inst Global Hlth, Sydney, NSW, Australia

[37] Univ Sydney, Sydney, NSW 2006, Australia

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2014年 / 370卷 / 16期

基金：

英国医学研究理事会; 加拿大健康研究院;

关键词：

RANDOMIZED CONTROLLED-TRIAL; LOW-DOSE ASPIRIN; MYOCARDIAL-INFARCTION; ACETYLSALICYLIC-ACID; PLATELET-FUNCTION; VASCULAR-DISEASE; THERAPY; PREVENTION; METAANALYSIS; ASSOCIATION;

D O I：

10.1056/NEJMoa1401105

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. Methods: Using a 2-by-2 factorial trial design, we randomly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. 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). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen. The primary outcome was a composite of death or nonfatal myocardial infarction at 30 days. Results: The primary outcome occurred in 351 of 4998 patients (7.0%) in the aspirin group and in 355 of 5012 patients (7.1%) in the placebo group (hazard ratio in the aspirin group, 0.99; 95% confidence interval [CI], 0.86 to 1.15; P=0.92). Major bleeding was more common in the aspirin group than in the placebo group (230 patients [4.6%] vs. 188 patients [3.8%]; hazard ratio, 1.23; 95% CI, 1.01, to 1.49; P=0.04). The primary and secondary outcome results were similar in the two aspirin strata. Conclusions: 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.)

引用

页码：1494 / 1503

页数：10

共 33 条

[31] Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial [J].

Taylor, DW ;

Barnett, HJM ;

Haynes, RB ;

Ferguson, GG ;

Sackett, DL ;

Thorpe, KE ;

Simard, D ;

Silver, FL ;

Hachinski, V ;

Clagett, GP ;

Barnes, R ;

Spence, JD .

LANCET, 1999, 353 (9171) :2179-2184

[32]

The CURRENT-OASIS 7 Investigators, 2010, N ENGL J MED, V363, P1585

[33]

The CURRENT-OASIS 7 Investigators, 2010, N ENGL J MED, V363, P930

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