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Apr 15, 2014

Stumbling Block in Attempt to Reduce Risk of Complications from Surgery

Aspirin and blood-pressure lowering medication fail to improve outcomes in surgical patients at risk for heart disease.

Aspirin and blood-pressure lowering drugs fail to improve outcomes for patients undergoing surgery, according to findings from two large research trials published in the New England Journal of Medicine.

Part of the POISE-2 (Perioperative Ischemic Evaluation 2) study, these trials aimed to reduce surgical complications in patients at risk for heart disease. One study tested the use of a blood-pressure lowering medication called clonidine (Catapres), while the other tested aspirin use, before and after non-cardiac surgery. The hope was that these common medications might lower risk of heart complications from surgery, such as heart attack and death, in patients with high cardiovascular risk. POISE-2 is the largest clinical trial of its kind and includes more than 10,000 patients from 135 medical centers around the world.

Unfortunately, neither study produced the results researchers had hoped for. In the first trial, researchers found that administering clonidine shortly before and after surgery actually increased risk of low blood pressure and cardiac arrest in patients. And after 30 days, there was no difference in risk of heart attack and death among patients taking clonidine vs. an inactive pill. As a result, study investigators advise against using this blood pressure-lowering medication to improve outcomes in patients with higher cardiovascular risk undergoing non-cardiac surgery.

Similarly, researchers also advise against aspirin use in patients without heart disease undergoing non-cardiac surgery. These recommendations are based on findings from the second POISE-2 trial, which tested aspirin use in patients immediately before and up to 30 days after surgery. Not only was there no difference in outcomes between patients taking aspirin vs. the inactive placebo, patients taking aspirin were more likely to experience major bleeding, a potentially serious complication from surgery.

Results of both trials were recently presented at the American College of Cardiology’s 63rd Annual Scientific Session, where more than 13,000 heart experts came together to focus on the prevention, diagnosis, and treatment of heart disease. And despite the disappointing findings from this study, experts hope to continue to identify ways to reduce risk of complications after surgery, particularly in patients with or at risk for heart disease.

Questions for You to Consider

  • How does aspirin help prevent heart attack and stroke?

  • Aspirin helps prevent heart attack and stroke by reducing blood clotting. Although blood clotting is the body’s natural way of healing damaged blood vessels, blood clots can travel to the heart and block major arteries, causing heart attack or stroke. Therefore, those at high risk for heart attack and stroke often take aspirin to help reduce clotting and risk for future cardiac events.
  • Who is considered high-risk for surgery?
  • Although all types of surgery carry some risk of complications, certain conditions can increase risk of complications from surgery, such as obesity, diabetes and heart disease. When considering surgery, it’s important to discuss possible risks and benefits of treatment plans with your doctor.

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