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Jean S. Bussières - One of the best experts on this subject based on the ideXlab platform.

  • Aspirin in Coronary Artery Surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular Surgery. We previously reported the 30-day results of a trial evaluating aspirin use before Coronary Artery Surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score  Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after Surgery.

  • Tranexamic acid in Coronary Artery Surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac Surgery but may increase the risk of Coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for Coronary Artery Surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after Surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of Surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after Surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having Coronary Artery Surgery, tranexamic acid did not affect death or severe disability through to 1 year after Surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

  • tranexamic acid in patients undergoing Coronary Artery Surgery
    The New England Journal of Medicine, 2017
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, James D Cooper, Jean S. Bussières
    Abstract:

    BackgroundTranexamic acid reduces the risk of bleeding among patients undergoing cardiac Surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. MethodsIn a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo Coronary-Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsOf the 4662 patients who were enrolled and provided consent, 4631 underwent Surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patien...

  • Stopping vs. continuing aspirin before Coronary Artery Surgery
    New England Journal of Medicine, 2016
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, Jayarajah M, Jean S. Bussières
    Abstract:

    BackgroundMost patients with Coronary Artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing Surgery, but it is unclear whether aspirin should be stopped before Coronary Artery Surgery. MethodsWe used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo Coronary Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsAmong 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo....

Paul S. Myles - One of the best experts on this subject based on the ideXlab platform.

  • Aspirin in Coronary Artery Surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular Surgery. We previously reported the 30-day results of a trial evaluating aspirin use before Coronary Artery Surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score  Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after Surgery.

  • Tranexamic acid in Coronary Artery Surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac Surgery but may increase the risk of Coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for Coronary Artery Surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after Surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of Surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after Surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having Coronary Artery Surgery, tranexamic acid did not affect death or severe disability through to 1 year after Surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

  • tranexamic acid in patients undergoing Coronary Artery Surgery
    The New England Journal of Medicine, 2017
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, James D Cooper, Jean S. Bussières
    Abstract:

    BackgroundTranexamic acid reduces the risk of bleeding among patients undergoing cardiac Surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. MethodsIn a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo Coronary-Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsOf the 4662 patients who were enrolled and provided consent, 4631 underwent Surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patien...

  • Stopping vs. continuing aspirin before Coronary Artery Surgery
    New England Journal of Medicine, 2016
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, Jayarajah M, Jean S. Bussières
    Abstract:

    BackgroundMost patients with Coronary Artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing Surgery, but it is unclear whether aspirin should be stopped before Coronary Artery Surgery. MethodsWe used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo Coronary Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsAmong 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo....

  • Aspirin and Coronary Artery Surgery: a systematic review and meta-analysis
    British Journal of Anaesthesia, 2015
    Co-Authors: Stuart Hastings, Paul S. Myles, David R. Mcilroy
    Abstract:

    Background Aspirin administration before cardiac Surgery represents a balance between preventing perioperative thrombotic events and promoting surgical bleeding. Clear evidence to guide the preoperative use of aspirin in patients undergoing cardiac Surgery is lacking. This systematic review and meta-analysis was performed to evaluate the efficacy and safety of preoperative aspirin, in patients undergoing Coronary Artery Surgery. Methods We conducted a systematic review and meta-analysis of randomized trials involving patients undergoing Coronary Artery Surgery assigned to preoperative aspirin therapy or no aspirin/placebo. The MEDLINE and EMBASE databases and Cochrane Central Register of Controlled Trials were searched up to March 2014 without language restrictions. Two reviewers performed independent quality review and data extraction. Efficacy outcomes of myocardial infarction (MI) and mortality, and safety outcomes of blood loss, red cell transfusion, and surgical re-exploration were compared. Results In 13 trials (n=2399), preoperative aspirin therapy reduced the risk of MI (OR, 0.56; 95% CI, 0.33–0.96; P=0.03), without a reduction in mortality (OR, 1.16; 95% CI, 0.42–3.22; P=0.77). Preoperative aspirin increased postoperative chest tube drainage (mean difference 168 ml; 95% CI, 39–297 ml; P=0.01), red cell transfusion (mean difference 141 ml; 95% CI, 55–226; P=0.001) and need for surgical re-exploration (OR, 1.85, 95% CI, 1.15–2.96; P=0.01). Studies were of low methodological quality, with significant heterogeneity identified. Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin reduces perioperative MI, but at a cost of increased bleeding, blood transfusion, and surgical re-exploration.

John J Mcneil - One of the best experts on this subject based on the ideXlab platform.

  • Aspirin in Coronary Artery Surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular Surgery. We previously reported the 30-day results of a trial evaluating aspirin use before Coronary Artery Surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score  Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after Surgery.

  • Tranexamic acid in Coronary Artery Surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac Surgery but may increase the risk of Coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for Coronary Artery Surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after Surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of Surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after Surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having Coronary Artery Surgery, tranexamic acid did not affect death or severe disability through to 1 year after Surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

  • tranexamic acid in patients undergoing Coronary Artery Surgery
    The New England Journal of Medicine, 2017
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, James D Cooper, Jean S. Bussières
    Abstract:

    BackgroundTranexamic acid reduces the risk of bleeding among patients undergoing cardiac Surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. MethodsIn a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo Coronary-Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsOf the 4662 patients who were enrolled and provided consent, 4631 underwent Surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patien...

  • Stopping vs. continuing aspirin before Coronary Artery Surgery
    New England Journal of Medicine, 2016
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, Jayarajah M, Jean S. Bussières
    Abstract:

    BackgroundMost patients with Coronary Artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing Surgery, but it is unclear whether aspirin should be stopped before Coronary Artery Surgery. MethodsWe used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo Coronary Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsAmong 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo....

  • Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: rationale and design.
    American Heart Journal, 2008
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, D. James Cooper, John J Mcneil, John L. Knight, Donald S. Esmore, Brian F. Buxton, Henry Krum, Andrew Forbes
    Abstract:

    Background Despite some concern that recent aspirin ingestion increases blood loss after Coronary Artery Surgery, there is some evidence that this may reduce thrombotic complications. In contrast, antifibrinolytic drugs can reduce blood loss in this setting, but there is concern that they may increase thrombotic complications. Published guidelines are limited by a lack of large randomized trials addressing the risks and benefits of each of these commonly used therapies in cardiac Surgery. The ATACAS Trial is a study comparing aspirin, tranexamic acid, or both, with placebo in patients undergoing on-pump or off-pump Coronary Artery Surgery. Methods We discuss the rationale for conducting ATACAS, a 4600-patient, multicenter randomized trial in at-risk Coronary Artery Surgery, and the features of the ATACAS study design (objectives, end points, target population, allocation, treatments, patient follow-up, and analysis). Conclusions The ATACAS Trial will be the largest study yet conducted to ascertain the benefits and risks of aspirin and antifibrinolytic therapy in Coronary Artery Surgery. Results of the trial will guide the routine clinical care of patients in this setting.

Brendan S. Silbert - One of the best experts on this subject based on the ideXlab platform.

  • Aspirin in Coronary Artery Surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular Surgery. We previously reported the 30-day results of a trial evaluating aspirin use before Coronary Artery Surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score  Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after Surgery.

  • Tranexamic acid in Coronary Artery Surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac Surgery but may increase the risk of Coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for Coronary Artery Surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after Surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of Surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after Surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having Coronary Artery Surgery, tranexamic acid did not affect death or severe disability through to 1 year after Surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

  • tranexamic acid in patients undergoing Coronary Artery Surgery
    The New England Journal of Medicine, 2017
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, James D Cooper, Jean S. Bussières
    Abstract:

    BackgroundTranexamic acid reduces the risk of bleeding among patients undergoing cardiac Surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. MethodsIn a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo Coronary-Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsOf the 4662 patients who were enrolled and provided consent, 4631 underwent Surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patien...

  • Stopping vs. continuing aspirin before Coronary Artery Surgery
    New England Journal of Medicine, 2016
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, Jayarajah M, Jean S. Bussières
    Abstract:

    BackgroundMost patients with Coronary Artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing Surgery, but it is unclear whether aspirin should be stopped before Coronary Artery Surgery. MethodsWe used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo Coronary Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsAmong 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo....

  • Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: rationale and design.
    American Heart Journal, 2008
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, D. James Cooper, John J Mcneil, John L. Knight, Donald S. Esmore, Brian F. Buxton, Henry Krum, Andrew Forbes
    Abstract:

    Background Despite some concern that recent aspirin ingestion increases blood loss after Coronary Artery Surgery, there is some evidence that this may reduce thrombotic complications. In contrast, antifibrinolytic drugs can reduce blood loss in this setting, but there is concern that they may increase thrombotic complications. Published guidelines are limited by a lack of large randomized trials addressing the risks and benefits of each of these commonly used therapies in cardiac Surgery. The ATACAS Trial is a study comparing aspirin, tranexamic acid, or both, with placebo in patients undergoing on-pump or off-pump Coronary Artery Surgery. Methods We discuss the rationale for conducting ATACAS, a 4600-patient, multicenter randomized trial in at-risk Coronary Artery Surgery, and the features of the ATACAS study design (objectives, end points, target population, allocation, treatments, patient follow-up, and analysis). Conclusions The ATACAS Trial will be the largest study yet conducted to ascertain the benefits and risks of aspirin and antifibrinolytic therapy in Coronary Artery Surgery. Results of the trial will guide the routine clinical care of patients in this setting.

Julian A. Smith - One of the best experts on this subject based on the ideXlab platform.

  • Aspirin in Coronary Artery Surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular Surgery. We previously reported the 30-day results of a trial evaluating aspirin use before Coronary Artery Surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score  Results Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P = .48). There was no significant difference in the rates of myocardial infarction (P = .11), stroke (P = .086), or death (P = .24), or a composite of these cardiovascular end points (P = .68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P = .03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P > .10). Conclusions In patients undergoing Coronary Artery Surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after Surgery.

  • Tranexamic acid in Coronary Artery Surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial
    The Journal of Thoracic and Cardiovascular Surgery, 2019
    Co-Authors: Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John J Mcneil, Jean S. Bussières
    Abstract:

    Abstract Background Tranexamic acid reduces blood loss and transfusion requirements in cardiac Surgery but may increase the risk of Coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for Coronary Artery Surgery. Here we report the 1-year clinical outcomes. Methods Using a factorial design, we randomly assigned patients undergoing Coronary Artery Surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after Surgery. Results The rate of death or disability at 1 year was 3.8% in the tranexamic acid group and 4.4% in the placebo group (relative risk, 0.85; 95% confidence interval, 0.64-1.13; P = .27), and this did not significantly differ according to aspirin exposure at the time of Surgery (interaction P = .073). The composite rate of myocardial infarction, stroke, and death up to 1 year after Surgery was 14.3% in the tranexamic acid group and 16.4% in the placebo group (relative risk, 0.87; 95% CI, 0.76-1.00; P = .053). Conclusions In this trial of patients having Coronary Artery Surgery, tranexamic acid did not affect death or severe disability through to 1 year after Surgery. Further work should be done to explore possible beneficial effects on late cardiovascular events.

  • tranexamic acid in patients undergoing Coronary Artery Surgery
    The New England Journal of Medicine, 2017
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Mohandas Jayarajah, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, James D Cooper, Jean S. Bussières
    Abstract:

    BackgroundTranexamic acid reduces the risk of bleeding among patients undergoing cardiac Surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. MethodsIn a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo Coronary-Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsOf the 4662 patients who were enrolled and provided consent, 4631 underwent Surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patien...

  • Stopping vs. continuing aspirin before Coronary Artery Surgery
    New England Journal of Medicine, 2016
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, Thomas Painter, Silvana Marasco, John J Mcneil, Andrew Forbes, Jayarajah M, Jean S. Bussières
    Abstract:

    BackgroundMost patients with Coronary Artery disease receive aspirin for primary or secondary prevention of myocardial infarction, stroke, and death. Aspirin poses a risk of bleeding in patients undergoing Surgery, but it is unclear whether aspirin should be stopped before Coronary Artery Surgery. MethodsWe used a 2-by-2 factorial trial design to randomly assign patients who were scheduled to undergo Coronary Artery Surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin trial are reported here. Patients were randomly assigned to receive 100 mg of aspirin or matched placebo preoperatively. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after Surgery. ResultsAmong 5784 eligible patients, 2100 were enrolled; 1047 were randomly assigned to receive aspirin and 1053 to receive placebo....

  • Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: rationale and design.
    American Heart Journal, 2008
    Co-Authors: Paul S. Myles, Julian A. Smith, Brendan S. Silbert, D. James Cooper, John J Mcneil, John L. Knight, Donald S. Esmore, Brian F. Buxton, Henry Krum, Andrew Forbes
    Abstract:

    Background Despite some concern that recent aspirin ingestion increases blood loss after Coronary Artery Surgery, there is some evidence that this may reduce thrombotic complications. In contrast, antifibrinolytic drugs can reduce blood loss in this setting, but there is concern that they may increase thrombotic complications. Published guidelines are limited by a lack of large randomized trials addressing the risks and benefits of each of these commonly used therapies in cardiac Surgery. The ATACAS Trial is a study comparing aspirin, tranexamic acid, or both, with placebo in patients undergoing on-pump or off-pump Coronary Artery Surgery. Methods We discuss the rationale for conducting ATACAS, a 4600-patient, multicenter randomized trial in at-risk Coronary Artery Surgery, and the features of the ATACAS study design (objectives, end points, target population, allocation, treatments, patient follow-up, and analysis). Conclusions The ATACAS Trial will be the largest study yet conducted to ascertain the benefits and risks of aspirin and antifibrinolytic therapy in Coronary Artery Surgery. Results of the trial will guide the routine clinical care of patients in this setting.