title: Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: rationale and design.
abstract: BACKGROUND
  Despite some concern that recent aspirin ingestion increases blood loss after coronary artery surgery, there is some evidence that this may reduce thrombotic complications. In contrast, antifibrinolytic drugs can reduce blood loss in this setting, but there is concern that they may increase thrombotic complications. Published guidelines are limited by a lack of large randomized trials addressing the risks and benefits of each of these commonly used therapies in cardiac surgery. The ATACAS Trial is a study comparing aspirin, tranexamic acid, or both, with placebo in patients undergoing on-pump or off-pump coronary artery surgery.
  
  
  METHODS
  We discuss the rationale for conducting ATACAS, a 4600-patient, multicenter randomized trial in at-risk coronary artery surgery, and the features of the ATACAS study design (objectives, end points, target population, allocation, treatments, patient follow-up, and analysis).
  
  
  CONCLUSIONS
  The ATACAS Trial will be the largest study yet conducted to ascertain the benefits and risks of aspirin and antifibrinolytic therapy in coronary artery surgery. Results of the trial will guide the routine clinical care of patients in this setting.
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia. p.myles@alfred.org.au
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
authors.forename: Julian
authors.initials: J
authors.lastname: Smith
authors.forename: John
authors.initials: J
authors.lastname: Knight
authors.forename: D James
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Brendan
authors.initials: B
authors.lastname: Silbert
authors.forename: John
authors.initials: J
authors.lastname: McNeil
authors.forename: Donald S
authors.initials: DS
authors.lastname: Esmore
authors.forename: Brian
authors.initials: B
authors.lastname: Buxton
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.forename: Andrew
authors.initials: A
authors.lastname: Forbes
authors.forename: Andrew
authors.initials: A
authors.lastname: Tonkin
mesh_terms: D000933:Antifibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D001026:Coronary Artery Bypass; D015340:Epidemiologic Research Design; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017410:Practice Guidelines as Topic; D014148:Tranexamic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000933:Antifibrinolytic Agents; D005343:Fibrinolytic Agents; D014148:Tranexamic Acid; D001241:Aspirin