- Question
- To determine whether giving aspirin before noncardiac surgery and through the early postoperative period reduces death or nonfatal myocardial infarction in patients at risk for vascular complications.
- Design
- International, randomized, double-blind, placebo-controlled trial with a 2-by-2 factorial design (aspirin or placebo, and clonidine or placebo), enrolling 10010 patients. Patients were stratified by whether they were not previously taking aspirin (initiation) or were already on it (continuation).
- Population
- Patients preparing to undergo noncardiac surgery who were at risk for vascular complications; 5628 in the aspirin initiation stratum and 4382 in the continuation stratum.
- Intervention
- Aspirin 200 mg just before surgery, then 100 mg daily for 30 days in the initiation stratum and for 7 days in the continuation stratum, after which patients resumed their regular aspirin regimen.
- Control
- Placebo given on the same schedule.
- Primary outcome
- Composite of death or nonfatal myocardial infarction at 30 days.
- Results
- The primary outcome occurred in 351 of 4998 patients (7.0%) on aspirin and 355 of 5012 (7.1%) on placebo (HR 0.99; 95% CI 0.86 to 1.15; P=0.92). Results were similar in both strata.
- Safety
- Major bleeding was more common with aspirin than placebo (230 patients [4.6%] vs. 188 [3.8%]; HR 1.23; 95% CI 1.01 to 1.49; P=0.04).
- Conclusion
- Perioperative aspirin did not significantly reduce death or nonfatal myocardial infarction but increased the risk of major bleeding.
- Why it matters
- The trial challenged routine perioperative aspirin use in noncardiac surgery by showing no benefit on the composite of death and myocardial infarction while increasing bleeding.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026