Journal of the American College of Cardiology (JACC)Aspirin in Patients With DES Undergoing Noncardiac Surgery

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The ASSURE DES trial investigated whether continuing aspirin monotherapy during noncardiac surgery provides benefits for patients with drug-eluting stents (DES) placed more than one year prior. This randomized controlled trial of 1,010 patients compared perioperative aspirin continuation versus complete antiplatelet cessation, measuring outcomes including mortality, myocardial infarction, stent thrombosis, and stroke.

Study Design:

• Randomized controlled trial with 1,010 patients (926 in modified intention-to-treat analysis)
• Inclusion criteria: Patients with DES placed >1 year prior requiring elective noncardiac surgery
• Two arms: Aspirin continuation (462 patients) vs. complete antiplatelet cessation (464 patients)
• Antiplatelet therapy resumed within 48 hours post-surgery when possible
• Primary outcome measured from 5 days pre-surgery to 30 days post-surgery

Key Findings:

• Primary composite outcome: 0.6% in aspirin group vs. 0.9% in no-antiplatelet group
• No stent thrombosis events in either group
• Major bleeding: Similar between groups (6.5% vs. 5.2%, p=0.39)
• Minor bleeding: Higher in aspirin group (14.9% vs. 10.1%, p=0.027)
• Study was underpowered due to lower-than-expected event rates

HCN Medical Memo
Although this study suggests potential flexibility in perioperative antiplatelet management for stable DES patients, its application should be limited to low-to-intermediate risk procedures more than one year post-stenting. The very low event rates observed indicate that individualized risk assessment remains crucial, particularly for high-risk patients or procedures not represented in this study.

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