POISE-2
PeriOperative ISchemic Evaluation-2 trial
Paciente / Población Intervención / Exposición Comparación Desenlace
In 10,010 patients at risk of vascular complications undergoing non-cardiac surgery, neither low-dose aspirin nor clonidine started just before surgery reduced death or non-fatal myocardial infarction at 30 days; aspirin increased major bleeding and clonidine increased hypotension, compared with placebo.
N
10.010
Diseño
2×2 factorial, double-blind, placebo-controlled RCT
Desenlace
Composite of death or non-fatal myocardial infarction at 30 days
Relevancia
1
ResultadoAspirin 7.0 % vs 7.1 % (HR 0.99; p=0.92) with major bleeding 4.6 % vs 3.8 % (HR 1.23; p=0.04). Clonidine HR 1.08 (p=0.29) with clinically important hypotension 47.6 % vs 37.1 % (p<0.001).
Devereaux PJ, Mrkobrada M, Sessler DI, et al. N Engl J Med. 2014;370(16):1494-1503. 10.1056/NEJMoa1401105
Discusión y crítica
Patients with recent coronary stents were excluded, so it cannot be extrapolated to dual antiplatelet therapy after recent PCI. Within its population it is decisive: it removed the rationale for routinely starting perioperative aspirin or clonidine.