Anesthesia Management: Is Perioperative Aspirin Necessary?

Aspirin in Patients Undergoing Noncardiac Surgery

Devereaux PJ, Mrkobrada M, Sessler DI, et al; POISE-2 Investigators

N Engl J Med. 2014;370:1494-1503

Does administration of aspirin during the perioperative period benefit patients undergoing noncardiac surgery? Devereaux and colleagues performed a randomized trial in 10,010 patients recruited from 135 hospitals in 23 countries. Patients undergoing orthopedic procedures formed the largest group (38%), followed by general surgery (27%) and urologic or gynecologic procedures (17%). The main outcome of the study was the 30-day risk for death or nonfatal myocardial infarction. In the aspirin group 7% of patients died or had a myocardial infarct compared with 7.1% of the nontreated patients (P = .92). The results were similar in patients with or without aspirin therapy prior to surgery.

This large, randomized, multicenter trial found no beneficial effect of aspirin administered during the perioperative period on mortality or risk for myocardial infarction.

Furthermore, significant bleeding was more common in the treated group: 4.6% vs 3.8%, P = .04. This study provides strong evidence that discontinuing aspirin during the postoperative period did not increase the risk for nonfatal myocardial infarction or death.

In an accompanying article, the same research group reported similar negative results on mortality and risk for myocardial infarction after administration of low-dose clonidine, a sympatholytic agent.