Aspirin in noncardiac surgery.

Noncardiac surgery associated with platelet activation, and coronary artery thrombus with myocardial infarction may occur perioperatively.

Perioperative aspirin may prevent major vascular complications by inhibiting thrombus formation.

In randomized trials aspirin prevent MI and major vascular events in patients not undergoing surgery.

High dose aspirin not superior to low dose aspirin in preventing vascular complications.

Low dose aspirin associated with fewer gastric toxic effects.

In a randomized trial of 10,010 patients with cardiovascular risk, undergoing noncardiac surgery with administration of aspirin or placebo before and throughout early postoperative period: aspirin had no effect on the rate of composite death, or no fatal MI, but increased the risk of major bleeding .(POISE-2 Investigators).

The CRISTAL study compared aspirin for thromboprophylaxis with enoxaparin, a low molecular weight heparin,  after primary total hip or knee arthroscopy for osteoarthritis and was found that the VTE rate was significantly lower with enoxaparin compared to aspirin (1.82% versus 3.5%): there was a greater number of the below knee DVT events in the aspirin group.

However, the rates postoperative mortality of 0.1% was low for both prophylactic anticoagulant and aspirin, and the incidence of clinically important VTE was low with aspirin,as well,  suggesting that major thrombolic events after total joint arthroplasty are uncommon with aspirin.

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