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


CONCLUSIONS
Contrary to recent findings, low dose aspirin is effective and medium dose aspirin did not prove superior for inhibiting platelet aggregation after coronary surgery.
Lim
Eric
E
Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, CB3 8RE, UK. eric.lim@cvsnet.org
Cornelissen
Jacqueline
J
Routledge
Tom
T
Ali
Ayyaz
A
Kirtland
Stephen
S
Sharples
Linda
L
Sheridan
Kate
K
Bellm
Sarah
S
Munday
Helen
H
Large
Stephen
S
D000244:Adenosine Diphosphate / Q000097:blood; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D003094:Collagen / Q000097:blood; D001026:Coronary Artery Bypass; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000244:Adenosine Diphosphate; D003094:Collagen; D001241:Aspirin; D004837:Epinephrine