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The POISE-2 randomized trial evaluated whether perioperative aspirin could reduce major cardiovascular events in patients undergoing noncardiac surgery who were at risk for vascular complications. Routine aspirin did not reduce the composite risk of death or nonfatal myocardial infarction, but it did increase clinically important bleeding. The result is highly relevant to perioperative decision-making because antiplatelet therapy can be intuitively attractive when cardiovascular risk is high, yet surgery changes the balance between thrombosis and bleeding. For surgeons, anesthetists and physicians, the practical lesson is not to start aspirin simply because a patient is undergoing major surgery. Instead, the decision should consider the indication for antiplatelet therapy, previous coronary intervention, cardiovascular risk, procedure-specific bleeding risk and the overall perioperative plan. The study also illustrates why large pragmatic trials are valuable: a common intervention that seems biologically plausible may not improve outcomes when used broadly. Individualized medication management remains essential, particularly in patients already receiving antiplatelet therapy for established cardiovascular disease.
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The POISE-2 randomized trial evaluated whether perioperative aspirin could reduce major cardiovascular events in patients undergoing noncardiac surgery who were at risk for vascular complications. Routine aspirin did not reduce the composite risk of death or nonfatal myocardial infarction, but it did increase clinically important bleeding. The result is highly relevant to perioperative decision-making because antiplatelet therapy can be intuitively attractive when cardiovascular risk is high, yet surgery changes the balance between thrombosis and bleeding. For surgeons, anesthetists and physicians, the practical lesson is not to start aspirin simply because a patient is undergoing major surgery. Instead, the decision should consider the indication for antiplatelet therapy, previous coronary intervention, cardiovascular risk, procedure-specific bleeding risk and the overall perioperative plan. The study also illustrates why large pragmatic trials are valuable: a common intervention that seems biologically plausible may not improve outcomes when used broadly. Individualized medication management remains essential, particularly in patients already receiving antiplatelet therapy for established cardiovascular disease.
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