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