Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial

Mantz, Jean; Samama, Charles‐Marc; Tubach, Florence; Devereaux, P. J.; Collet, Jean Philippe; Albaladéjo, Pierre; Cholley, Bernard; Nizard, R.; Barré, J; Piriou, Vincent; Poirier, Nancy; Mignon, Alexandre; Schlumberger, S.; Longrois, Dan; Aubrun, Frédéric; Farèse, M.E.; Ravaud, Philippe; Steg, Philippe Gabriel

doi:10.1093/bja/aer274

Cited by 176 publications

(79 citation statements)

References 33 publications

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“…Although the power is limited, there is no significant difference between two groups, according to age, sex, operation, and study period. To our knowledge, the only randomized study, conducted for all types of surgery, had to be prematurely stopped due to the insufficient patient inclusions (1).…”

Section: Discussionmentioning

confidence: 99%

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Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Menahem¹,

Plard²,

Fiant³

et al. 2014

OALib

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Purpose: To assess the risks of digestive surgery in patients under antiplatelet therapy. Increasing numbers of patients requiring a surgical digestive procedure are on APT. Several studies have shown that APT interruption during the perioperative period increased thrombotic risks, while in the case of maintaining APT, hemorrhagic complications were not increased. Methods: We included prospectively all patients under APT who were operated on from September 1, 2010 to October 31, 2011. Two groups were defined: patients who interrupted APT and those who maintained APT. Three surgical categories were distinguished, with Group I involving parietal surgery, Group II common abdominal surgery, and Group III complex abdominal surgery. The primary endpoints were hemorrhagic and thrombotic risks. Results: Among the 2047 patients undergoing digestive surgery, 130 (6.5%) were on APT, with 32 in Group APT− and 98 in Group APT+. In the overall series, patients taking APT did not receive significantly more transfusions. APT was significantly associated with a higher rate of bleeding complications and transfusion requirement in patients undergoing complex and major abdominal surgery (0% vs. 28%, p = 0.03). In Group APT−, only one patient out of 32 (3.1%) suffered from a thrombotic event involving a myocardial infarction. Conclusions: This study suggests stopping APT at least 5 -7 days in patients undergoing complex and major abdominal surgery. In this other case, APT may be maintained without an increased risk of hemorrhage.

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Section: Discussionmentioning

confidence: 99%

“…Several retrospective studies as well as a prospective randomized trial [1] have shown that the interruption of APT was associated with an increased risk of thrombosis. Moreover, APT maintenance was not associated with a significantly higher hemorrhagic risk.…”

Section: Introductionmentioning

confidence: 99%

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Menahem¹,

Plard²,

Fiant³

et al. 2014

OALib

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show abstract

“…Both of these studies recommended discontinuation of dual antiplatelet therapy and continuation of a single agent. Since prior studies have shown that aspirin may not increase the risk of bleeding complications to the extent that clopidogrel does, it may be safest to recommend continuation of aspirin alone in these patients [22].…”

Section: Video-assisted Thoracic Surgerymentioning

confidence: 99%

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

2017

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There has been great progress in antithrombotic therapy over the past several years. Its use has increased with the advent of novel anticoagulants, as these medications do not require frequent blood tests for monitoring. Antithrombotic therapy is aimed at reducing the risk of thromboembolic events in patients with atrial fibrillation, coronary artery disease, deep vein thrombosis, valvular heart disease and pulmonary embolism. These patients are often critically ill and frequently undergo urgent interventions requiring discontinuation of anticoagulant or antiplatelet therapy which can increase the risk of thrombosis; however, continuing these agents can lead to increased risk of haemorrhage.The purpose of this article is to summarise the literature surrounding the safety of using antiplatelet and anticoagulant therapies in patients undergoing interventional pulmonary procedures.

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“…RCTs showed mixed results but with a potential decreased risk of vascular events in patients on ASA in the perioperative period [46][47][48]. In contrast, the PEP trial, involving 13 356 patients undergoing hip surgery, demonstrated more cardiac ischaemic events (death due to ischaemic heart disease or nonfatal MI) in patients randomised to ASA versus placebo (HR 1.33, 95% CI 1.00-1.78) [49].…”

Section: Aspirinmentioning

confidence: 99%

Prevention, epidemiology, and prognosis of perioperative myocardial injury

2016

Cardiovasc Med

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SummaryAnnually over 200 million adults undergo noncardiac surgery worldwide.Myocardial ischaemia is a frequent cause of perioperative cardiac morbidity and mortality. Approximately 8 million patients will suffer a myocardial injury after noncardiac surgery (MINS) each year. MINS is defined as a prognostically important myocardial injury due to ischaemia that occurs during, or within 30 days after, noncardiac surgery. The diagnostic criterion for MINS is an elevated troponin measurement resulting from myocardial ischaemia. MINS is a strong, independent predictor of 30-day and 1-year mortality. The majority of patients suffering MINS would go undetected without troponin monitoring since >80% of these patients do not experience ischaemic symptoms. Intensification of pharmacotherapy may reduce 30-day mortality in patients who have experienced MINS. This pape r will review the epidemiology, prevention, prognosis and treatment of MINS.

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Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial

Abstract: In these at-risk patients undergoing elective non-cardiac surgery, we did not find any difference in terms of occurrence of major thrombotic or bleeding events between preoperative maintenance or interruption of aspirin.

Cited by 176 publications

References 33 publications

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

Prevention, epidemiology, and prognosis of perioperative myocardial injury

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Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial

Abstract: In these at-risk patients undergoing elective non-cardiac surgery, we did not find any difference in terms of occurrence of major thrombotic or bleeding events between preoperative maintenance or interruption of aspirin.

Cited by 176 publications

References 33 publications

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Digestive Surgery in Patients Treated with Antiplatelet Agents: How Risky?

Management of anticoagulant and antiplatelet therapy in patients undergoing interventional pulmonary procedures

Prevention, epidemiology, and prognosis of perioperative ­myocardial injury

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Product

Resources

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Prevention, epidemiology, and prognosis of perioperative myocardial injury