Aspirin can prevent heart attacks after noncardiac surgery in patients with prior PCI

November 14, 2017, University of Alberta Faculty of Medicine & Dentistry
Graham found that aspirin can help prevent heart attacks in non-cardiac surgery patients who previously had a coronary procedure such as an angioplasty or stent. Credit: Melissa Fabrizio

A Canadian-led study has found that perioperative aspirin can prevent heart-related complications after major noncardiac surgery in patients with previous percutaneous coronary intervention (PCI) such as an angioplasty or stent.

The study found that for every 1,000 with PCI, giving them at the time of would prevent 59 heart attacks and cause eight major bleeding events. The results of this study are significant, given that 200 million adults undergo major noncardiac surgery annually.

These results were a substudy of POISE-2, a large international study with sites in 135 centres in 23 countries, including Edmonton. Patients with previous PCI were enrolled in 82 centres in 21 countries.

Noncardiac surgeries occur daily at hospitals around the world, so the study results will have a big impact on this patient group.

"This is your next-door neighbour who had angioplasty five years ago, feels fine and needs to go in for hip surgery. It affects quite a large number of people," said Michelle Graham, an interventional cardiologist, professor in the University of Alberta's Department of Medicine and lead of the substudy. "We believe that perioperative aspirin in this group of patients will most likely benefit them and reduce their risk of serious vascular complications."

In patients without a PCI, POISE-2 found that aspirin did not reduce the risk of heart attack and led to an increased risk of major bleeding.

Of the 10,010 participants enrolled in the POISE-2, 470 had a previous PCI. Since patients with a prior PCI have an increased risk of cardiovascular complications after noncardiac surgery, the group wanted to see if the findings were the same in the subgroup.

This was the largest randomized trial of patients with PCI undergoing major noncardiac surgery. Although the study found that aspirin reduced the risk of , it did slightly increase the risk of bleeding, though it did not appear worse than in the overall POISE-2 trial.

"There will be a big knowledge translation push with our colleagues in anesthesia and to remind them we want them to continue aspirin in this group of patients, when for most other groups we're recommending they stop," says Graham.

The Canadian Cardiovascular Society guidelines published last year indicated that aspirin should not be given in the perioperative period.

"This will potentially change the practice of anyone who does perioperative medicine," said Graham.

Graham recognizes that studies like this are not possible without the participation of patients.

"We could not advance the field of medicine without the patients that participate in trials like POISE-2," said Graham. "This really is a team sport, we need the surgeons, anesthesiologist and patients on board to make it successful."

The study 'Aspirin in Patients with Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery' was published in Annals of Internal Medicine on November 14, 2017.

Explore further: Rate of death, heart attack after noncardiac surgery decreases, although risk of stroke increases

More information: Annals of Internal Medicine (2017). DOI: 10.7326/M17-2341

Related Stories

Rate of death, heart attack after noncardiac surgery decreases, although risk of stroke increases

December 28, 2016
In a study published online by JAMA Cardiology, Sripal Bangalore, M.D., M.H.A., of the New York University School of Medicine, New York, and colleagues examined national trends in perioperative cardiovascular outcomes and ...

Major bleeds rise with perioperative aspirin for non-cardiac surgery

March 31, 2014
Patients given aspirin to prevent heart problems after non-heart-related surgery had a higher risk of serious bleeding than the patients who did not receive aspirin. At the same time, aspirin did not reduce incidence of post-operative ...

Elevated biomarker following surgery linked to increased risk of death

April 25, 2017
Among patients undergoing noncardiac surgery, peak postoperative high-sensitivity troponin T measurements (proteins that are released when the heart muscle has been damaged) during the first three days after surgery were ...

Aspirin before non-cardiac surgery is ineffective and often harmful

April 9, 2014
(Medical Xpress)—Queen's University and Kingston General Hospital researchers are part of a groundbreaking international study that has shown that starting – or continuing – to take Aspirin before non-cardiac surgery ...

Aspirin or blood pressure medication before and after surgery does not reduce risk of AKI

November 15, 2014
In patients undergoing noncardiac surgery, neither aspirin nor clonidine (a medication primarily used to treat high blood pressure) taken before and after surgery reduced the risk of acute kidney injury, according to a study ...

Research reveals aspirin is safe for heart surgery patients

February 25, 2016
A worldwide study led by Monash University clinician-researchers shows that patients who take aspirin before heart surgery are at no greater risk of bleeding or complications. 

Recommended for you

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

Heart-muscle patches made with human cells improve heart attack recovery

January 10, 2018
Large, human cardiac-muscle patches created in the lab have been tested, for the first time, on large animals in a heart attack model. This clinically relevant approach showed that the patches significantly improved recovery ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.