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Open Access Highly Accessed Research article

Biological efficacy of low versus medium dose aspirin after coronary surgery: results from a randomized trial [NCT00262275]

Eric Lim1*, Jacqueline Cornelissen1, Tom Routledge1, Ayyaz Ali1, Stephen Kirtland1, Linda Sharples2, Kate Sheridan1, Sarah Bellm1, Helen Munday1 and Stephen Large1

Author Affiliations

1 Departments of Cardiothoracic Surgery and Clinical Pharmacology, Papworth Hospital, Cambridge, CB3 8RE, UK

2 Medical Research Council Biostatistics Unit, Cambridge, UK

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BMC Medicine 2006, 4:12  doi:10.1186/1741-7015-4-12

Published: 22 May 2006

Abstract

Background

The beneficial effect of aspirin after coronary surgery is established; however, a recent study reported the inability of low doses (100 mg) to inhibit postoperative platelet function. We conducted a double-blind randomised trial to establish the efficacy of low dose aspirin and to compare it against medium dose aspirin.

Methods

Patients undergoing coronary surgery were invited to participate and consenting patients were randomised to 100 mg or 325 mg of aspirin daily for 5 days. Our primary outcome was the difference in platelet aggregation (day 5 – baseline) using 1 μg/ml of collagen. Secondary outcomes were differences in EC50 of collagen, ADP and epinephrine (assessed using the technique of Born).

Results

From September 2002 to April 2004, 72 patients were randomised; 3 patients discontinued, leaving 35 and 34 in the low and medium dose aspirin arms respectively. The mean aggregation (using 1.1 μg/ml of collagen) was reduced in both the medium and low dose aspirin arms by 37% and 36% respectively. The baseline adjusted difference (low – medium) was 6% (95% CI -3 to 14; p = 0.19). The directions of the results for the differences in EC50 (low – medium) were consistent for collagen, ADP and epinephrine at -0.07 (-0.53 to 0.40), -0.08 (-0.28 to 0.11) and -4.41 (-10.56 to 1.72) respectively, but none were statistically significant.

Conclusion

Contrary to recent findings, low dose aspirin is effective and medium dose aspirin did not prove superior for inhibiting platelet aggregation after coronary surgery.