Authors: Myles PS et al., N Engl J Med 2016 Feb 25; 374:728
It neither helps nor harms, but continuing the medication might be the wiser choice.
A common question with patients undergoing coronary artery surgery is whether to discontinue aspirin. Inexplicably, we have little evidence to guide our practice. To address this issue, researchers randomized 2100 patients scheduled for surgery and at risk for complications because of age or comorbidities to preoperative aspirin (100 mg) or placebo; treatments were manufacturer-supplied. Patients had not taken aspirin ≥4 days. The study was modified because of low enrollment and was recalculated to have a 96% power to detect a relative difference of 30% in the primary outcome, a composite of death and thrombotic complications within 30 days of surgery.
The primary endpoint occurred in 19% of the aspirin group and 20% of the placebo group, a nonsignificant difference (relative risk, 0.94). There were no significant between-group differences in postoperative myocardial infarction or bleeding.
Discontinuing aspirin before coronary artery surgery provided neither a benefit nor a harm in this study. The results do not suggest a change in clinicians’ current practice, although it may be prudent to continue the aspirin so as not to risk forgetting to restart it.