Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial

Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Using...

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Bibliographic Details
Published in:	The Journal of thoracic and cardiovascular surgery Vol. 157; no. 2; pp. 633 - 640
Main Authors:	Myles, Paul S., Smith, Julian A., Kasza, Jessica, Silbert, Brendan, Jayarajah, Mohandas, Painter, Thomas, Cooper, D. James, Marasco, Silvana, McNeil, John, Bussières, Jean S., McGuinness, Shay, Chan, Matthew T.V., Wallace, Sophie, Forbes, Andrew
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2019
Subjects:	Aged anesthesia Antifibrinolytic Agents - administration & dosage Antifibrinolytic Agents - adverse effects antiplatelet Aspirin - administration & dosage Aspirin - adverse effects Coronary Artery Bypass - adverse effects Coronary Artery Bypass - mortality Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - mortality Coronary Artery Disease - surgery Coronary Thrombosis - etiology Coronary Thrombosis - mortality Coronary Thrombosis - prevention & control Disability Evaluation disability-free survival Double-Blind Method Female Fibrinolytic Agents - administration & dosage Fibrinolytic Agents - adverse effects Hemorrhage - chemically induced Hemorrhage - mortality Hemorrhage - prevention & control Humans major adverse cardiac events Male Middle Aged Myocardial Infarction - etiology Myocardial Infarction - mortality Myocardial Infarction - prevention & control outcome Progression-Free Survival Risk Factors Time Factors Tranexamic Acid - administration & dosage Tranexamic Acid - adverse effects major adverse cardiac events MACE ADL antiplatelet outcome ATACAS anesthesia disability-free survival
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Summary:	Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-News-3 ObjectType-Feature-4 content type line 23 ObjectType-Undefined-2
ISSN:	0022-5223 1097-685X
DOI:	10.1016/j.jtcvs.2018.08.114