Perioperative aspirin therapy in non-cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. (1st May 2018)

• Record Type: Journal Article
• Authors: Wolff, Georg; Navarese, Eliano Pio; Brockmeyer, Maximilian; Lin, Yingfeng; Karathanos, Athanasios; Kołodziejczak, Michalina; Kubica, Jacek; Polzin, Amin; Zeus, Tobias; Westenfeld, Ralf; Andreotti, Felicita; Kelm, Malte; Schulze, Volker
• Is Part Of: International journal of cardiology. Volume 258(2018)
• Page Start: 59
• Page End: 67
• Publication Date: 2018-05-01
• Subjects: ACC American College of Cardiology -- ACCP American College of Chest Physicians -- AHA American Heart Association -- ASA acetyl salicylic acid -- BARC Bleeding Academic Research Consortium -- CABG coronary artery bypass graft -- CI confidence interval -- CVD cardiovascular disease -- DM diabetes mellitus -- ESC European Society of Cardiology -- HLP hyperlipoproteinemia -- HTN hypertension -- LOE level of evidence -- M–H Mantel–Haenszel -- MI myocardial infarction -- n/a not available -- NSAR non-steroid anti-rheumatic drug -- OR odds ratio -- PAOD peripheral artery occlusive disease -- PCI percutaneous coronary intervention -- PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses -- RCT randomized controlled trial -- TIA transient ischemic attack -- VTE venous thromboembolism; Aspirin -- Surgery -- Bleeding -- Mortality -- Myocardial infarction -- Cardiovascular disease -- Thromboembolism -- Stroke; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.12.088
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Aspirin is a key element in prevention of cardiovascular and thromboembolic events. During non-cardiac surgery however, its balance of bleeding risks and benefits remains unclear. Methods: A systematic review and meta-analysis of randomized controlled trials was performed. Online databases were screened for clinical trials randomizing aspirin to no aspirin therapy in non-cardiac surgery. Clinical outcomes of all-cause mortality and cardiovascular mortality, arterial ischemic events, venous thromboembolic events and bleeding events were separately evaluated. Results: Seven RCTs comprising 28, 302 patients were included. All-cause mortality (3.7% vs. 3.8%; odds ratio (OR) 0.97, CI 0.86–1.10) and cardiovascular mortality (2.0% vs. 2.1%, OR 0.92; CI 0.78–1.09) were not different in aspirin vs. no aspirin groups. Arterial ischemic events showed no differences, including myocardial infarction (2.5% (aspirin) vs. 2.5% (no aspirin)), cerebrovascular events (0.6% (aspirin) vs. 0.6% (no aspirin)) and peripheral arterial events (0.2% (aspirin) vs. 0.3% (no aspirin)). Aspirin significantly reduced the risk for venous thromboembolic events (VTE; 1.5% (aspirin) vs. 2.0% (no aspirin); OR 0.74, CI 0.59–0.94, p = 0.02). Perioperative major bleeding was significantly more frequent in aspirin groups (4.4% vs. 3.7%; OR 1.18, CI 1.05 to 1.33, p = 0.007). Conclusion: Aspirin remained neutral with respect to overall survival, cardiovascular mortality and arterial ischemic events. It reduced venous thromboembolic events at the expense of perioperative major bleedings. Thus, this analysis supports recommendations against perioperative aspirin continuation/initiation in cardiovascular disease patients at intermediate risk, as well as recommendations of aspirin for VTE prophylaxis in orthopedic patients only. Highlights: Comprehensive meta-analysis of RCTs on aspirin therapy in non-cardiac surgery Differentiation of arterial ischemic, venous thromboembolic and bleeding events No benefits to survival and cardiovascular mortality by perioperative aspirin Reduced thromboembolic events, but more major bleedings under aspirin