Document Detail


Aspirin and mortality from coronary bypass surgery.
MedLine Citation:
PMID:  12397188     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is no therapy known to reduce the risk of complications or death after coronary bypass surgery. Because platelet activation constitutes a pivotal mechanism for injury in patients with atherosclerosis, we assessed whether early treatment with aspirin could improve survival after coronary bypass surgery. METHODS: At 70 centers in 17 countries, we prospectively studied 5065 patients undergoing coronary bypass surgery, of whom 5022 survived the first 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes. RESULTS: During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3 percent (40 of 2999 patients), as compared with 4.0 percent among those who did not receive aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with a 48 percent reduction in the incidence of myocardial infarction (2.8 percent vs. 5.4 percent, P<0.001), a 50 percent reduction in the incidence of stroke (1.3 percent vs. 2.6 percent, P=0.01), a 74 percent reduction in the incidence of renal failure (0.9 percent vs. 3.4 percent, P<0.001), and a 62 percent reduction in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74). CONCLUSIONS: Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.
Authors:
Dennis T Mangano;
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  347     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-24     Completed Date:  2002-10-30     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1309-17     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2002 Massachusetts Medical Society
Affiliation:
Ischemia Research and Education Foundation, San Francisco, CA 94134, USA. dtb@iref.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Antifibrinolytic Agents / therapeutic use
Aspirin / therapeutic use*
Coronary Artery Bypass / mortality*
Coronary Disease / mortality,  surgery*
Female
Humans
Ischemia / epidemiology,  mortality,  prevention & control
Male
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Transfusion
Postoperative Care
Postoperative Complications / epidemiology,  mortality,  prevention & control*
Prospective Studies
Single-Blind Method
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin
Comments/Corrections
Comment In:
N Engl J Med. 2003 Mar 13;348(11):1057-9; author reply 1057-9   [PMID:  12638576 ]
N Engl J Med. 2003 Mar 13;348(11):1057-9; author reply 1057-9   [PMID:  12637618 ]
N Engl J Med. 2006 May 4;354(18):1953-7; author reply 1953-7   [PMID:  16672711 ]
N Engl J Med. 2006 May 4;354(18):1953-7; author reply 1953-7   [PMID:  16673531 ]
N Engl J Med. 2006 May 4;354(18):1953-7; author reply 1953-7   [PMID:  16673530 ]
N Engl J Med. 2002 Oct 24;347(17):1359-60   [PMID:  12397195 ]
N Engl J Med. 2006 May 4;354(18):1953-7; author reply 1953-7   [PMID:  16673529 ]

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