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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)

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. P...

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Main Authors: Antolovič, Dalibor (Author) , Rakow, Anastasia (Author) , Contin, Pietro (Author) , Ulrich, Alexis (Author) , Rahbari, Nuh Nabi (Author) , Büchler, Markus W. (Author) , Weitz, Jürgen (Author) , Koch, Moritz (Author)
Format: Article (Journal)
Language:English
Published: 2012
In: Langenbeck's archives of surgery
Year: 2011, Volume: 397, Issue: 2, Pages: 297-306
ISSN:1435-2451
DOI:10.1007/s00423-011-0867-7
Online Access:Verlag, Volltext: http://dx.doi.org/10.1007/s00423-011-0867-7
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Author Notes:D. Antolovic, A. Rakow, P. Contin, A. Ulrich, N. N. Rahbari, M. W. Büchler, J. Weitz, M. Koch

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245 1 2 |a 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  |b the APAP trial (ISRCTN45810007)  |c D. Antolovic, A. Rakow, P. Contin, A. Ulrich, N. N. Rahbari, M. W. Büchler, J. Weitz, M. Koch 
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520 |a 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 long-term 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. 
534 |c 2011 
650 4 |a Adult 
650 4 |a Aged 
650 4 |a Aspirin 
650 4 |a Blood Loss, Surgical 
650 4 |a Cholecystectomy 
650 4 |a Colorectal Surgery 
650 4 |a Dose-Response Relationship, Drug 
650 4 |a Drug Administration Schedule 
650 4 |a Elective Surgical Procedures 
650 4 |a Follow-Up Studies 
650 4 |a Herniorrhaphy 
650 4 |a Humans 
650 4 |a Perioperative Care 
650 4 |a Pilot Projects 
650 4 |a Platelet Aggregation Inhibitors 
650 4 |a Postoperative Hemorrhage 
650 4 |a Reference Values 
650 4 |a Risk Assessment 
650 4 |a Surgical Procedures, Operative 
650 4 |a Thromboembolism 
650 4 |a Treatment Outcome 
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