Should clinicians continue using aspirin for patients with prior percutaneous coronary intervention (PCI) who are undergoing noncardiac surgery? The answer appears to be yes based on the results of a new study from Canada. Researchers excluded those who had received a bare-metal stent within six weeks, placement of a drug-eluting stent within one year, or nonstudy aspirin within 72 hours of surgery. About 470 patients with previous PCI were randomized to aspirin or placebo, initiated four hours before surgery and continued throughout the perioperative period. The outcomes death or nonfatal myocardial infarction were reduced by 5.5% by aspirin therapy (absolute risk reduction, 5.5%; 95% CI, 0.4-10.5; HR, 0.50; 95% CI, 0.26-0.95; P for interaction = 0.036). The risk for myocardial infarction was reduced by more than half (absolute risk reduction, 5.9%; 95% CI, 1.0-10.8; HR, 0.44; 95% CI, 0.22-0.87; P for interaction = 0.021). The effect on bleeding was “uncertain,” with an absolute risk increase of 1.3% (Ann Intern Med 2018;168:237-244).
An accompanying editorial stated that this study is an “important contribution to the field of cardiovascular management of patients who require noncardiac surgery. In the absence of a very high bleeding risk, low-dose aspirin should be continued or resumed during the perioperative period among patients with previous coronary stents.” (Ann Intern Med 2018;168:289-290)