A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery - The APAP trial (ISRCTN45810007)

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • D. Antolovic - , Heidelberg University  (Author)
  • A. Rakow - , Heidelberg University  (Author)
  • P. Contin - , Heidelberg University  (Author)
  • A. Ulrich - , Heidelberg University  (Author)
  • N. N. Rahbari - , Heidelberg University  (Author)
  • M. W. Büchler - , Heidelberg University  (Author)
  • J. Weitz - , Heidelberg University  (Author)
  • M. Koch - , Heidelberg University  (Author)

Abstract

Purpose: Surgeons are increasingly confronted by patients on long-term low-dose acetylsalicylic acid (ASA). However, owing to a lack of evidence-based data, a widely accepted consensus on the perioperative management of these patients in the setting of non-cardiac surgery has not yet been reached. Primary objective was to evaluate the safety of continuous versus discontinuous use of ASA in the perioperative period in elective general or abdominal surgery. Methods: Fifty-two patients undergoing elective cholecystectomy, inguinal hernia repair or colonic/colorectal surgery were recruited to this pilot study. According to cardiological evaluation, non-high-risk patients who were on longterm treatment with low-dose ASA were eligible for inclusion. Patients were allocated randomly to continuous use of ASA or discontinuation of ASA intake for 5 days before until 5 days after surgery. The primary outcome was the incidence of major haemorrhagic and thromboembolic complications within 30 days after surgery. Results: A total of 26 patients were allocated to each study group. One patient (3.8%) in the ASA continuation group required re-operation due to post-operative haemorrhage. In neither study group, further bleeding complications occurred. No clinically apparent thromboembolic events were reported in the ASA continuation and the ASA discontinuation group. Furthermore, there were no significant differences between both study groups in the secondary endpoints. Conclusions: Perioperative intake of ASA does not seem to influence the incidence of severe bleeding in non-high-risk patients undergoing elective general or abdominal surgery. Further, adequately powered trials are required to confirm the findings of this study.

Details

Original languageEnglish
Pages (from-to)297-306
Number of pages10
JournalLangenbeck's archives of surgery
Volume397
Issue number2
Publication statusPublished - Feb 2012
Peer-reviewedYes
Externally publishedYes

External IDs

PubMed 22048442

Keywords

ASJC Scopus subject areas

Keywords

  • Acetylsalicylic acid, Aspirin, Complications, Perioperative management, Risk factors