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Randomised controlled trial
Questions linger over POISE-2 and perioperative aspirin management
  1. Neal Stuart Gerstein1,
  2. Gerald A Charlton2,3
  1. 1Division of Cardiac Anesthesia, Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  2. 2Division of Cardiology, Department of Internal Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
  3. 3Division of Cardiology, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  1. Correspondence to: Dr Neal Stuart Gerstein, Division of Cardiac Anesthesia, Department of Anesthesiology, University of New Mexico School of Medicine, MSC10 6000, Albuquerque, NM 87131, USA; ngerstein{at}salud.unm.edu

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Context

Aspirin therapy for secondary prevention in patients with cardiovascular (CV) disease was catalysed by the Antithrombotic Trialists’ Collaboration meta-analysis in which antiplatelet therapy (primarily aspirin) demonstrated a 22% reduction in mortality from any vascular cause.1 Based on this meta-analysis and American Heart Association (AHA) guidelines, high-risk patients (those with coronary artery, cerebrovascular or peripheral vascular disease) should be prescribed aspirin indefinitely.2 For primary prevention, aspirin is equivocal except in patients with diabetes with certain additional risks.3

The recent Perioperative Ischaemic Evaluation-2 (POISE-2) Trial is the largest prospective study to date designed to clarify the issues surrounding perioperative aspirin management. There were two components of POISE-2: perioperative aspirin versus placebo and perioperative clonidine versus placebo. This paper addresses the aspirin component.

Methods

POISE-2 was a randomised, controlled, multicentre, international …

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