A recent study has looked at whether giving aspirin prior to surgery can help those who take aspirin and also those who do not (NEJM 2014; 1494-503).  This trial called POISE-2 (Perioperative Ischemic Evaluation 2) was undertaken to determine if low-dose aspirin, as compared to placebo, would affect 30-day risk of death or nonfatal myocardial infarction.

The relevance of this study relates to aspirin’s known potential for preventing venous thromboembolism and the fact that “one-third of patients undergoing noncardiac surgery who are at risk for major vascular complications receive perioperative aspirin.”

The study enrolled 10,010 patients and employed a 2-by-2 trial design to account for whether they had been taking aspirin.  The study took place between 2010-2013 at 135 hospitals and 23 countries.  Mean age was 68 years in both groups.

Results:

• The rate of death was similar in both groups: 7.0% for aspirin and 7.1% for placebo (hazard ratio 0.99)
• Major bleeding was more common with aspirin than placebo: 4.6% vs. 3.8% (P=0.04).

Bottomline: Perioperative aspirin had no significant beneficial effect.

Related study: NEJM 2014; 370: 1504-13.  Conclusion: “Administration of low-dose clonidien in patients undergoing noncardiac surgery did not reduce the rate of” death or nonfatal myocardial infarction.  Patients who received clonidine had more frequent hypotension and nonfatal cardiac arrest.