Continuation Of Aspirin Research Articles

Does Aspirin Increase Risk of Bleeding in Patients Undergoing Skin Lesion Excision: A Systematic Review and Meta-Analysis.

Aspirin is a commonly prescribed medication, which impairs the action of platelets. This also results in a higher risk of bleeding. Cutaneous lesion excision is frequently performed for diagnosis and treatment of malignancies, as well as for aesthetic or functional benefits. We must balance the risk of bleeding against the risk of discontinuing aspirin. We conducted a systematic review, and meta-analysis, in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to evaluate the evidence of postoperative bleeding risk conferred by continuation of aspirin in cutaneous surgery. A systematic search of the literature was performed. Included studies evaluated the incidence of hemorrhage or hematoma in adults undergoing cutaneous surgery. The following participant characteristics were noted: age, sex, surgical site, and type of wound closure performed. A random-effects model was chosen to calculate the effect size-expressed as odds ratio (OR) with a 95% confidence interval-for bleeding of any severity, moderate severity, severe severity, infection, and wound dehiscence (outcomes). A total of 26,860 procedures were included from 20 studies. A statistically significant increase in odds of bleeding of any severity (16,748 procedures included) OR 1.39 (1.02-1.90) and for bleeding of severe severity (12,311 procedures included) OR 2.46 (1.53-3.95) was identified. Moderate severity bleeding (1629 procedures included) OR 0.92 (0.46-1.81), infection OR 0.60 (0.28-1.28), and wound dehiscence OR 0.92 (0.41-2.06) effect size results did not attain statistical significance. Our analysis identified a statistically significant increase in postoperative bleeding risk for patients taking aspirin and undergoing cutaneous surgery.

Perioperative Management of Patients on Chronic Aspirin Therapy for Elective Brain Surgery: A Delphi Study.

The perioperative management of chronic aspirin therapy in patients undergoing elective brain surgery is challenging due to the risk of bleeding and thromboembolic events. Although aspirin discontinuation reduces the bleeding risk, it can increase thrombotic complications, particularly in patients at high risk of cardiovascular complications. This Delphi study aimed to develop consensus-based guidelines to address these clinical challenges. A 2-round Delphi survey was conducted among an international panel of 42 experienced anesthesiologists and neurosurgeons. Participants assessed the risks and benefits of perioperative aspirin management, including bleeding risk, thrombotic risk, timing of cessation and resumption, and the utility of platelet function testing. Consensus was defined as ≥80% agreement in round 2. Round 1 highlighted significant variability in practice patterns. In round 2, consensus was reached on several key areas. Most experts (84%) agreed that continuing aspirin increases perioperative bleeding risk in high-risk procedures, with 87% recommending discontinuing aspirin 5 to 7 days before surgery. Nearly all experts (97%) supported continuing low-dose aspirin in high-thrombotic-risk patients. Conversely, for low-thrombotic-risk patients, only 65% agreed on aspirin continuation, reflecting an ongoing debate. No consensus was reached regarding routine platelet function testing. This Delphi study provides experience-based recommendations for managing chronic aspirin therapy in neurosurgical patients. The panel strongly supports aspirin continuation in high-thrombotic-risk patients, with cessation 5 to 7 days before high-bleeding-risk surgeries. Individualized management is advised for low-bleeding-risk procedures and low-thrombotic-risk patients. Future research should further clarify aspirin management in these groups and explore the role of platelet function testing in neurosurgical settings.

Aspirin Continuation or Discontinuation in Surgically Treated Chronic Subdural Hematoma

Discontinuation of low-dose acetylsalicylic acid (ASA) during the perioperative phase of treatment for chronic subdural hematoma (cSDH) may reduce recurrence rates but may also increase the risk of cardiovascular or thromboembolic events. However, the efficacy and safety of discontinuing ASA in this patient population remain unclear. To assess the risk of recurrence of cSDH and cardiovascular events in patients undergoing surgical treatment of cSDH with continuous vs discontinuous ASA treatment. The SECA (Surgical Evacuation of Chronic Subdural Hematoma and Aspirin) trial was an investigator-initiated, multicenter, placebo-controlled randomized clinical trial conducted from February 2018 to June 2023 at 6 neurosurgical centers in Switzerland. Adults undergoing burr hole drainage for cSDH and receiving ASA treatment prior to cSDH onset were included. Of 1363 screened patients, 155 were included. Both assessors and participants were blinded to the treatment arms. Participants were randomized 1:1 to receive either continuous ASA or placebo for 12 days during the perioperative phase. The main outcome was the recurrence rate of cSDH necessitating reoperation within 6 months. An intention-to-treat analysis was performed, calculating risk differences. Secondary outcomes were cardiovascular or thromboembolic events, other bleeding events, and mortality. Of 155 participants, 78 were assigned to continuous ASA and 77 to placebo treatment. The mean (SD) participant age was 77.9 (8.2) years and 77.6 (9.7) years for the ASA and placebo groups, respectively, and 25 participants (16.1%) were female. A primary outcome event occurred in 13.9% of participants for the ASA group and 9.5% for the placebo group (weighted risk difference, 4.4%; 95% CI, -7.2% to 15.9%; P = .56). The incidence of any cardiovascular or thromboembolic event was 0.27 per person half-year in the ASA group and 0.28 in the placebo group. The incidence of a cardiovascular event indicating ASA treatment was 0.02 per person half-year in the ASA group and 0.06 in the placebo group. Other bleeding events showed an incidence of 0.10 per person half-year in the ASA group and 0.08 in the placebo group. All-cause mortality occurred at an incidence of 0.06 per person half-year in the ASA group and 0.03 in the placebo group. The SECA randomized clinical trial suggests that discontinuing ASA treatment did not reduce the recurrence rate of surgically treated cSDH within 6 months. Recurrence risk estimates for continuous ASA treatment in this trial were distinctly lower than previously reported. ClinicalTrials.gov Identifier: NCT03120182.

Safety of Laparoscopic Hernia Surgery in Patients With Preoperative Antiplatelet Continuation Therapy.

Introduction The optimal perioperative antithrombotic management of patients receiving antithrombotic therapy (ATT) remains controversial. In this study, we investigated the safety and feasibility of laparoscopic hernia surgery in patients taking ATT, especially those with a preoperative continuation of single antiplatelet therapy (APT). Methods Three hundred ninety-six (396) patients who underwent laparoscopic hernia surgery between April 2014 and March 2023 in our institution were retrospectively reviewed. The patients were divided into two groups: patients who continued single aspirin monotherapy preoperatively (continued single aspirin therapy (cAPT) group; n = 118) and patients who did not receive APT preoperatively (non-APT group; n = 278). Our perioperative antithrombotic management included preoperative continuation of single aspirin therapy for patients with APT or interruption of oral anticoagulation therapy (ACT), bridging anticoagulation with unfractionated heparin or direct-acting oral anticoagulants (DOAC) replacement for patients with ACT. The primary outcome was postoperative bleeding complications (BC). Results There were four postoperative BCs (Clavien-Dindo classification≧Ⅱ) (1.0%) in the whole cohort, one (0.9%) in the cAPT group, and three (1.1%) in the non-APT group, which were not significantly differentiated (p = 0.8330). Multivariable analysis showed heparin or DOAC replacement was an independently and significantly risk factor for postoperative bleeding (p = 0.0029, odds ratio (OR) = 32.6). Continuation of preoperative aspirin was not a risk factor for postoperative BCs. No thromboembolic complications occurred in the whole cohort. Conclusion We can safely and feasibly perform laparoscopic hernia surgery under preoperative antithrombotic management, including the preoperative continuation of single aspirin therapy, without any increase in bleeding events. However, careful consideration is required for the patient who received heparin bridging or DOAC replacement.

Pharmacologic agents for perioperative cardioprotection in noncardiac surgery.

This review will discuss the current pharmacologic strategies for mitigation of perioperative myocardial. State-of-the-art benefits and harms of pharmacologic interventions to delineate knowledge gaps in current guidelines and clinical practice will be presented. Beta-blockers are known to reduce major adverse cardiac events but inappropriate preoperative initiation results in adverse outcomes. Renin-Angiotensin-Aldosteron System (RAAS) inhibitors once universally discontinued before surgery are now under reconsideration as continuation seems not to be associated with increased risk. Statins continue to be the cornerstone due to their pleiotropic effect. Continuation of aspirin is supported perioperatively if the bleeding risk due to surgery is low to moderate. A few studies have investigated a strategy of strict intraoperative blood pressure control but failed to observe a meaningful effect on outcome. Whether prompt intensification of treatment in case of diagnosis of myocardial injury after noncardiac surgery improves outcome remains to be established. Since the MANAGE trial, no new studies have prospectively addressed this question. New data have questioned previous ideas and suggest a more nuanced, personalized approach to perioperative management. Accordingly, future studies should address refinement in risk stratification, optimization of pharmacologic strategies, and the development of novel therapies in attempting to enhance outcomes in high-risk surgical populations.

Safety of Continuous Low-dose Aspirin Therapy for Lumbar Decompression Alone

Whether the benefits of continued perioperative aspirin therapy in spinal surgery outweigh the risk of perioperative complications remains unclear. This study evaluates the perioperative effects of continuous low-dose aspirin treatment in patients who underwent lumbar decompression alone. This single-institute retrospective study included patients who underwent lumbar decompression for L1/2-L5/S1 lesions. The patient characteristics, perioperative parameters, and complications were compared between 103 patients who continued to take 100 mg/day aspirin during the perioperative period (aspirin group) and 653 patients who did not take antiplatelet or anticoagulant drugs (nonaspirin group). A significantly higher proportion of the patients in the aspirin group were males. The patients in the aspirin group had significantly lower preoperative hemoglobin levels than those in the non-aspirin group (P=0.001 and P=0.044, respectively). No significant differences were detected between the groups in terms of the number of disc decompression levels, duration of surgery, intraoperative blood loss, postoperative drainage volume, number of reoperations required for epidural hematoma formation, or perioperative blood transfusions. No cardiovascular or cerebrovascular ischemic events occurred in either group. Continuous low-dose aspirin therapy alone during the perioperative period for lumbar decompression did not increase perioperative bleeding or the risk of bleeding-related complications. In conclusion, continuous low-dose aspirin treatment may be acceptable for use in preventing the increased risk of cardiovascular disease caused by aspirin withdrawal in patients undergoing lumbar decompression.

Perioperative Safety of Lumbar Decompression Surgery Performed Under Continuous Low-Dose Aspirin Administration.

Retrospective clinical analysis. To investigate the changes in perioperative bleeding and overall safety associated with the use of low-dose aspirin (LDA) in spinal surgery. There is no consensus on whether to continue the use of LDA in patients requiring spinal surgery. Furthermore, previous studies have shown inconsistent results regarding the impact of LDA on the risk of intraoperative and postoperative bleeding. A retrospective cohort study was conducted at a single institution from 2014 to 2023, involving 375 patients diagnosed with lumbar spinal stenosis. Of these, 98 were on LDA therapy and 207 were not. After excluding those on other antiplatelet or anticoagulant therapies, propensity score matching was applied, resulting in two groups of 89 patients each. The study assessed variables such as operative time, intraoperative blood loss, postoperative drain volume, and hemoglobin level changes up to one week post-surgery. The LDA treated group (L group) experienced significantly higher intraoperative blood loss (70.3ml) compared to the non-LDA treated group (N group) (46.4ml, P =0.003). Postoperative drain volumes did not differ significantly, but postoperatively, hemoglobin levels decreased by 2.2g/dL in the L group and by 1.9g/dL in the N group after one week ( P =0.04). There were no significant differences in the rate of postoperative transfusions or serious bleeding complications between the groups. Although LDA use was associated with increased intraoperative blood loss and a significant drop in postoperative hemoglobin levels, it did not lead to serious bleeding complications. These findings suggest that with careful management, LDA can be safely continued in patients undergoing lumbar decompression surgery. However, the generalizability of these results is limited by the observational nature of the study and its single-center design. 3.

Effectiveness of aspirin in preventing deep vein thrombosis following proximal femoral fracture surgery in Japan

Previous studies have shown that aspirin is effective as a prophylactic agent against venous thromboembolism (VTE) following proximal femoral fractures (PFF). In Japan, there is a lack of evidence regarding its efficacy and safety in this context. Consequently, aspirin is not covered by insurance for the prevention of venous thrombosis. This study aimed to investigate whether continued aspirin use in patients with PFF, who were already taking aspirin for cerebrovascular disease prevention before injury is effective as a prophylaxis for deep vein thrombosis (DVT). We retrospectively analyzed PFF patients (≥ 65 years) who underwent postoperative duplex ultrasonography from January 2010 to December 2023.The study compared patients taking aspirin alone (aspirin group) and those not taking antiplatelet agents or anticoagulants (control group), matched by propensity scores. We enrolled 1064 patients while 161 (15%) were in the aspirin group. After matching, 128 patients were analyzed. DVT incidence was not statistically significant between the aspirin (54) and control groups (60) (OR: 0.81; 95%CI: 0.49- 1.36; p = 0.44). Proximal DVT incidence was also similar (OR: 2; 95%CI: 0.50–7.00; p = 0.33). Additionally, since use of other postoperative antithrombotic prophylaxis (78%) is thought to have a significant impact on the incidence of DVT, a subgroup analysis was conducted to evaluate the effect of aspirin in patients who did not receive postoperative antithrombotic prophylaxis. Similarly, there was no statistically significant difference in either DVT (OR: 1.38; 95% CI: 0.55–3.42; p = 0.49) or proximal DVT (OR: 2.00; 95% CI: 0.37–10.92; p = 0.42). This study demonstrates that aspirin is not effective for preventing VTE in patients with PFF in Japan.

Abstract 4139675: Short- and long-term impact of aspirin cessation in older adults: a target trial emulation.

Background: The net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD). Methods: Post-hoc analysis using a target trial emulation framework (Table 1) applied to the immediate post-trial period (2017-2021) of a study of low-dose aspirin initiation in 19,114 adults aged 70 years and older (ASPREE; NCT01038583). Participants from Australia and US were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0 (Fig 1A). The two groups in the target trial were: aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term), and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models. Results: We included 6,103 CVD-free participants (cessation: 5,427, continuation: 676). Participant selection flow chart is presented in Fig 1B. Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE and all-cause mortality (HRs, at 3 and 48 months respectively were, 1.23 and 0.73 for CVD; 1.11 and 0.84 for MACE; 0.23 and 0.79 for all-cause mortality, p >0.05) but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p <0.05) (Fig 1C). Similar findings were seen for all outcomes at 6 and 12 months, except for a lowered risk of all-cause mortality in the cessation group at 12 months (Fig 1C). Conclusions: Our findings support the safety of deprescribing prophylactic aspirin used for primary prevention in older adults.

Long-Term Effects of Low-Dose Aspirin on Gastrointestinal Symptoms and Bleeding Complications in Patients with Type 2 Diabetes.

Low-dose aspirin for primary prevention is determined by the balance of risks of cardiovascular events and adverse effects. We assessed the long-term gastrointestinal symptoms or bleeding with low-dose aspirin in diabetic patients. The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial was a randomized clinical trial to evaluate the efficacy and safety of low-dose aspirin in patients with type 2 diabetes. As a posthoc analysis, we investigated the incidence of upper gastrointestinal symptoms or bleeding in aspirin (100 mg enteric-coated aspirin or 81 mg buffered aspirin daily) and no-aspirin groups within and beyond 3 years. Of 2535 patients (mean age 65 years, 55% male) followed for a median of 11.2 years, 1258 were included in the aspirin group (951 enteric-coated, 208 buffered, 99 unknown) and 1277 were included in the no-aspirin group. The cumulative incidence of upper gastrointestinal symptoms or bleeding was higher in the aspirin group than the no-aspirin group (8.8% vs. 5.7% at 18 years; p<0.0001). The increased risk in the aspirin group was prominent within 3 years, and thehazard ratio (HR) [95% confidence interval (CI)] of the aspirin group was 7.10 [3.21-15.7], but attenuated beyond 3years (HR 1.20 [0.76-1.89]). In 1159 patients in the aspirin group, the cumulative incidence was lower in the enteric-coated than in the buffered aspirin groups (2.9% vs. 7.3%; p=0.003) within 3 years, and the adjusted HR of enteric-coated aspirin was 0.38 [0.20-0.72] compared with the buffered aspirin group. The upper gastrointestinal symptoms or bleeding of low-dose aspirin within 3 years, and the aspirin formulations, were relevant for decision making of initiation and continuation of low-dose aspirin for primary prevention.

Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery

Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery

To be or not to be on: aspirin and coronary artery bypass graft surgery.

Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of re-infarction, the evidence is less definitive for elective CABG procedures. The literature indicates a significant benefit of aspirin in reducing cardiovascular events in CAD patients, yet its impact on perioperative outcomes in CABG surgery is less clear. Some studies suggest increased bleeding risks without substantial improvement in cardiac outcomes. Specific to elective CABG, evidence is mixed, with some data indicating no significant difference in thrombotic or bleeding complications whether aspirin is continued or withheld preoperatively. Advancements in pharmacological therapies and perioperative care have evolved significantly since the initial aspirin trials, raising questions about the contemporary relevance of earlier findings. Individualized patient assessments and the development of risk stratification tools are needed to optimize perioperative aspirin use in CABG surgery. Further research is essential to establish clearer guidelines and improve patient outcomes. The objective of this review is to critically evaluate the existing evidence into the optimal management of perioperative aspirin in elective CABG patients.

Short- and long-term impact of aspirin cessation in older adults: a target trial emulation

BackgroundThe net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD).MethodsPost hoc analysis using a target trial emulation framework applied to the immediate post-trial period (2017–2021) of a study of low-dose aspirin initiation in adults aged ≥ 70 years (ASPREE; NCT01038583). Participants from Australia and the USA were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0. The two groups in the target trial were as follows: aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term) and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models.ResultsWe included 6103 CVD-free participants (cessation: 5427, continuation: 676). Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE, and all-cause mortality (HRs, at 3 and 48 months respectively, were 1.23 and 0.73 for CVD, 1.11 and 0.84 for MACE, and 0.23 and 0.79 for all-cause mortality, p > 0.05), but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p < 0.05). Similar findings were seen for all outcomes at 6 and 12 months, except for a lowered risk of all-cause mortality in the cessation group at 12 months.ConclusionsOur findings suggest that deprescribing prophylactic aspirin might be safe in healthy older adults with no known CVD.

Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease

Background Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. Methods This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. Results High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41–0.83], 0.49 [0.25–0.95], 0.57 [0.40–0.81], and 0.70 [0.55–0.88], respectively). Kaplan–Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). Conclusion Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.

Aspin: neurosurgical aspirin intervention prognostic study — perioperative continuation versus discontinuation of aspirin in lumbar spinal surgery, a randomized controlled, noninferiority trial

RationaleAspirin is typically discontinued in cranial and spinal surgery because of the increased risk of hemorrhagic complications, but comes together with the risk of resulting in an increase of cardiac and neurologic thrombotic perioperative events.ObjectiveThe aim of this study is to investigate the non-inferiority of perioperative continuation of aspirin patients undergoing low complex lumbar spinal surgery, compared with the current policy of perioperative discontinuation of aspirin.Study designA randomized controlled trial with two parallel groups of 277 cases (554 in total).Study populationPatients undergoing low complex lumbar spinal surgery and using aspirin. All patients are aged >18 years.InterventionPeri-operative continuation of aspirin.Study outcomesPrimary study outcome: composite of the following bleeding complications:Neurological deterioration as a result of hemorrhage in the surgical area with cauda and/or nerve root compression.Post-surgical anemia with hemoglobin level lower than 5 mmol/l, requiring transfusion.Subcutaneous hematoma leading to wound leakage and pain higher than NRS=7.Major and/or minor hemorrhage in any other body system according to the definition of the International Society on Thrombosis and Haemostasis bleeding scale.Secondary study outcomes:Each of the individual components of the primary outcomeAbsolute mean difference in operative blood loss between the study armsThrombo-embolic-related complications:Myocardial infarctionVenous thromboembolismStrokeArterial thromboembolismFurther study outcomesAnticoagulant treatment satisfaction by the Anti-Clot Treatment Scale (ACTS) and general health by the Patient-Reported Outcomes Measurement Information System (PROMIS Global-10) in the pre- and postoperative phase.Nature and extent of the burden and risks associated with participation, benefit, and group relatednessParticipation in this study imposes no additional risk to patients. Currently, there is no consensus on whether or not aspirin should be discontinued before cranial or spinal surgery. Currently, aspirin is typically discontinued in cranial and spinal surgery, because of a potential increased risk of hemorrhagic complication. An argument not based on a clinical trial. However, this policy might delay surgical procedures or carry the risk of resulting in an increase in cardiac and neurologic thrombotic perioperative events. It is unclear if the possibility of an increase in hemorrhage-related complications outweighs the risk of an increase in cardiac and neurologic thrombotic perioperative events.Furthermore, the Data Safety Monitoring Board (DSMB) will be asked for safety analysis by monitoring the study.There are no further disadvantages to participating in this study. Outcome measurements are recorded during admission and regular outpatient visits, and thus, do not require additional visits to the hospital.

Safety and complications of continuation of aspirin therapy in patients undergoing robot-assisted laparoscopic simple prostatectomy

To evaluate the safety and feasibility of continued perioperative aspirin at the time of robotic assisted simple prostatectomy (RASP). We performed a retrospective review of our IRB approved institutional database of patients who underwent RASP between 2013 and 2022. Comparative groups included patients taking aspirin in the perioperative period and those not taking aspirin pre-operatively. The primary outcome was any post-operative bleeding related complication using the modified Clavien–Dindo classification. Secondary outcomes included the identification of risk factors for increased blood loss in the entire study population, operative time, and blood transfusion requirement. 143 patients underwent RASP of which 55 (38.5%) patients continued perioperative aspirin therapy and 88 (61.5%) patients did not. Baseline demographics were similar between groups. Patients taking perioperative aspirin had a higher rate of hypertension (74.5% vs 58.0%, p = 0.04) and other cardiovascular disease (30.9% vs 11.4%, p = 0.007). Postoperative complications were similar between the groups (Clavien-Dindo ≥ 3; p = 0.43). Median blood loss (150 cc vs 150 cc, p = 0.38), percentage drop in hemoglobin (13.4 vs 13.2, p = 0.94) and blood transfusion rate (3.6 vs 1.1, p = 0.56) were also similar between groups. The median blood loss was 150 ml for the whole study population. On regression analysis, neither aspirin nor any other variable was associated with increased blood loss (> 150 ml). Aspirin can be safely continued perioperatively in patients undergoing RASP without any risk of bleeding related complications, blood loss, or increased transfusion rate.

Preoperative continuation of aspirin before isolated heart valve surgery and postoperative bleeding and transfusion: a single-center retrospective study

Background The risks and benefits of preoperative aspirin continuation in patients undergoing isolated heart valve replacement surgery are unclear. We investigated the effect of aspirin continuation on the risk of bleeding and transfusion in these patients. Methods In this single center, retrospective study, among 474 adult patients who underwent isolated heart valve surgery between April 2013 and June 2018, 269 continued aspirin within 5 days before surgery (aspirin group) and 205 patients did not take or stopped aspirin no later than 5 days before surgery (non-aspirin group). The chi-square test, the Mann-Whitney U-test, and the Student’s T-test were used to compare data between the groups. Univariate and Multivariate logistic regressions were used to assess crude and adjusted relationships between outcome and exposure. Results The primary outcome, red blood cell (RBC) transfusion, occurred in 59 patients (22%) of the aspirin group and in 24 patients (12%) of the non-aspirin group (p = 0.004). After adjustment for confounding factors, continuation of aspirin was no longer associated with RBC transfusion (aOR1.8;95%CI,0.98–3.2;p = 0.06). The amount of allogenic blood products, the incidence of surgical re-exploration for bleeding, the volume of re-transfused cell-saved blood, and the cumulative chest tube drainage during the first 24 postoperative hours were similar between groups. Conclusion Preoperative continuation of aspirin in patients undergoing isolated heart valve surgery is neither associated with a higher incidence of RBC transfusion, nor with larger perioperative blood loss, or more frequent surgical revision for bleeding. Trial registration Clinicaltrials.gov (NCT05151796)

Perioperative aspirin and coronary artery bypass graft surgery: a meta-analysis of randomised controlled trials

Abstract Background Although consensus guidelines demonstrate clear benefit for the continuation of aspirin in patients awaiting coronary artery bypass grafting (CABG) following an acute coronary syndrome where risk of re-infarction outweighs bleeding risk, the evidence remains unclear in the case of elective CABG. We performed the largest to date systematic review and meta-analysis to compare outcomes between CABG patients who stopped and continued aspirin perioperatively. Methods A thorough search of PubMed, MEDLINE and CENTRAL databases was conducted to 25th July 2022 for randomized control trials that evaluated patients undergoing CABG. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity. Results 16 eligible studies were included with a total of 6188 patients who underwent CABG. Patients who continued Aspirin perioperatively demonstrated an increased risk of all cause mortality [OR 1.37 (0.81-2.33)] and reduced risk of perioperative myocardial infarction [OR 0.81 (0.55-1.18)], however neither were statistically significant. No significant difference was observed between low-dose and higher doses of Aspirin. There was minimal heterogeneity amongst included studies (i2 = 0%, p=0.97 and i2=33%, p=0.13 respectively). Continuing aspirin produced a modest increase in postoperative blood loss [mean difference 66.12mL (-1.45-133.69)], as was a dose greater than 100mg [216.87(-152.99-586.72), p=0.60], however this was not statistically significant. Conclusion Continuing Aspirin before CABG is not associated with a significantly increased risk of all-cause mortality, of perioperative myocardial infarction, and of postoperative bleeding. Future trials with more robust methodology should be aimed at further evaluating this patient cohort to guide perioperative Aspirin use.

Safety and Efficacy of Ticagrelor Monotherapy in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention: An Individual Patient Data Meta-Analysis of TWILIGHT and TICO Randomized Trials.

Dual antiplatelet therapy with a potent P2Y12 inhibitor coupled with aspirin for 1 year is the recommended treatment for patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). As an alternative, monotherapy with a P2Y12 inhibitor after a short period of dual antiplatelet therapy has emerged as a bleeding reduction strategy. We pooled individual patient data from randomized trials that included patients with ACS undergoing PCI treated with an initial 3-month course of dual antiplatelet therapy followed by ticagrelor monotherapy versus continued ticagrelor plus aspirin. Patients sustaining a major ischemic or bleeding event in the first 3 months after PCI were excluded from analysis. The primary outcome was Bleeding Academic Research Consortium type 3 or 5 bleeding occurring between 3 and 12 months after index PCI. The key secondary end point was the composite of death, myocardial infarction, or stroke. Hazard ratios and 95% CIs were generated using Cox regression with a one-stage approach in the intention-to-treat population. The pooled cohort (n=7529) had a mean age of 62.8 years, 23.2% were female, and 55% presented with biomarker-positive ACS. Between 3 and 12 months, ticagrelor monotherapy significantly reduced Bleeding Academic Research Consortium 3 or 5 bleeding compared with ticagrelor plus aspirin (0.8% versus 2.1%; hazard ratio, 0.37 [95% CI, 0.24-0.56]; P<0.001). Rates of all-cause death, myocardial infarction, or stroke were not significantly different between groups (2.4% versus 2.7%; hazard ratio, 0.91 [95% CI, 0.68-1.21]; P=0.515). Findings were unchanged among patients presenting with biomarker-positive ACS. Among patients with ACS undergoing PCI who have completed a 3-month course of dual antiplatelet therapy, discontinuation of aspirin followed by ticagrelor monotherapy significantly reduced major bleeding without incremental ischemic risk compared with ticagrelor plus aspirin. URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42023449646.

Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy?

Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy?