Division of Anaesthesiology, Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden.
Br J Anaesth. 2010 Mar;104(3):305-12. doi: 10.1093/bja/aeq003.
Major adverse cardiac events (MACEs) are a common cause of death after non-cardiac surgery. Despite evidence for the benefit of aspirin for secondary prevention, it is often discontinued in the perioperative period due to the risk of bleeding.
We conducted a randomized, double-blind, placebo-controlled trial in order to compare the effect of low-dose aspirin with that of placebo on myocardial damage, cardiovascular, and bleeding complications in high-risk patients undergoing non-cardiac surgery. Aspirin (75 mg) or placebo was given 7 days before surgery and continued until the third postoperative day. Patients were followed up for 30 days after surgery.
A total of 220 patients were enrolled, 109 patients received aspirin and 111 received placebo. Four patients (3.7%) in the aspirin group and 10 patients (9.0%) in the placebo group had elevated troponin T levels in the postoperative period (P=0.10). Twelve patients (5.4%) had an MACE during the first 30 postoperative days. Two of these patients (1.8%) were in the aspirin group and 10 patients (9.0%) were in the placebo group (P=0.02). Treatment with aspirin resulted in a 7.2% absolute risk reduction [95% confidence interval (CI), 1.3-13%] for postoperative MACE. The relative risk reduction was 80% (95% CI, 9.2-95%). Numbers needed to treat were 14 (95% CI, 7.6-78). No significant differences in bleeding complications were seen between the two groups.
In high-risk patients undergoing non-cardiac surgery, perioperative aspirin reduced the risk of MACE without increasing bleeding complications. However, the study was not powered to evaluate bleeding complications.
非心脏手术后，主要心脏不良事件（MACE）是常见的死亡原因。尽管阿司匹林对二级预防有益，但由于出血风险，它在围手术期经常被停用。
我们进行了一项随机、双盲、安慰剂对照试验，旨在比较低剂量阿司匹林与安慰剂对非心脏手术高危患者心肌损伤、心血管和出血并发症的影响。阿司匹林（75mg）或安慰剂在术前 7 天内给予，并持续至术后第 3 天。患者在术后 30 天内接受随访。
共纳入 220 例患者，109 例接受阿司匹林治疗，111 例接受安慰剂治疗。阿司匹林组有 4 例（3.7%）和安慰剂组有 10 例（9.0%）患者术后肌钙蛋白 T 水平升高（P=0.10）。在术后 30 天内，有 12 例（5.4%）患者发生 MACE。其中 2 例（1.8%）在阿司匹林组，10 例（9.0%）在安慰剂组（P=0.02）。阿司匹林治疗可使术后 MACE 的绝对风险降低 7.2%（95%可信区间，1.3-13%），相对风险降低 80%（95%可信区间，9.2-95%），需要治疗的人数为 14 人（95%可信区间，7.6-78）。两组间出血并发症无显著差异。
在非心脏手术的高危患者中，围手术期使用阿司匹林可降低 MACE 的风险，而不增加出血并发症。然而，该研究未对出血并发症进行评估。
