Low-dose aspirin reduces peri-op complications
Endarterectomy in the news
Low-dose aspirin reduces peri-op complications
According to British investigators, low-dose aspirin is more efficacious than high-dose aspirin in reducing perioperative complication rates in patients undergoing carotid endarterectomy. The ASA and ACE trial examined the effect of various doses of aspirin on complications during the three months following surgery.1
Procedure also carries risks
Endarterectomy can be beneficial to certain patients with carotid stenosis, but its benefits are lessened by perioperative risks. "Aspirin can lower the risk of stroke in patients under-going the procedure, but how much?" asked investigators. To determine an optimum dose of aspirin, they compared four measures — 81 mg, 325 mg, 650 mg, and 1,300 mg — on more than 2,800 patients and surveyed outcomes at 30 days and three months. They found that the rate of combined stroke, myocardial infarction, and death was lower in the two low-dose groups than in the high-dose groups:
Low-dose aspirin | High-dose aspirin | |
Stroke | 3.2% | 6.9% |
Myocardial infarction | 0.9% | 3.3% |
Total mortality | 1.6% | 2.2% |
The existence of symptoms prior to surgery had a significant impact on morbidity and mortality, the authors report. Perioperative stroke and death occurred in 6.4% of patients with symptoms, compared to 4.6% of patients who had no symptoms.
The investigators note that the results are applicable only to a narrow group of carotid endarterectomy patients and warn against over-generalization of results.
Reference
1. Taylor DW, Barnett HJM, Haynes RB, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: A randomised controlled trial. Lancet 1999; 353:2,179-2,184.
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