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ATACAS: Preoperative aspirin fails to affect outcomes after coronary artery surgery
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In patients who underwent coronary artery surgery, preoperative aspirin had no effect on death or thrombotic complications at 30 days, according to findings published in The New England Journal of Medicine.
However, preoperative aspirin in that setting did not increase risk for bleeding compared with placebo, researchers found.
For the ATACAS trial, which attempted to determine whether aspirin, commonly taken by patients with CAD, should be stopped before coronary artery surgery, Paul S. Myles, MPH, MD, and colleagues randomly assigned 2,100 patients (mean age, 66 years; 82% men) aspirin 100 mg or placebo preoperatively. All patients had not been taking aspirin regularly before enrollment or had stopped at least 4 days before surgery. Approximately 75% of patients underwent primary CABG.
The primary outcome was first incidence of death, nonfatal MI, stroke, pulmonary embolism, renal failure or bowel infarction at 30 days. Prespecified secondary outcomes included death, nonfatal MI, major hemorrhage requiring reoperation, cardiac tamponade and required transfusion, all at 30 days.
The trial was a 2x2 factorial design in which patients were also assigned tranexamic acid or placebo. The results related to tranexamic acid have not yet been published.
Myles, from The Alfred Hospital and Monash University, Melbourne, Australia, and colleagues found that the primary outcome occurred in 19.3% of the aspirin group and 20.4% of the placebo group (RR = 0.94; 95% CI, 0.8-1.12).
They also found no difference between the groups at 30 days for death (aspirin, 1.3%; placebo, 0.9%; RR = 1.56; 95% CI, 0.68-3.6), nonfatal MI (aspirin, 13.8%; placebo, 15.8%; RR = 0.87; 95% CI, 0.71-1.07), major hemorrhage leading to reoperation (aspirin, 1.8%; placebo, 2.1%; RR = 0.87; 95% CI, 0.47-1.6), cardiac tamponade (aspirin, 1.1%; placebo, 0.4%; RR = 2.77; 95% CI, 0.88-8.66) or any measure of transfusion.
Overall postoperative MI occurred at a higher rate than normally seen in observational studies of CABG, but the researchers attributed that to the use of troponin surveillance and an otherwise stringent review of patients.
“The absence of an adverse bleeding effect in this trial could be explained by patient selection, the low dose of aspirin used (100 mg), or the use of antifibrinolytic therapy in half the patients,” Myles and colleagues wrote.
However, they found no interaction between aspirin and tranexamic acid in risk for the primary outcome or for major hemorrhage. – by Erik Swain
Disclosure: The aspirin and placebo for the study were supplied by Bayer for free. The researchers report no relevant financial disclosures.
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