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Cited by 530Cerebrovascular and Carotid Artery DiseasesAntiplatelet Therapy and Cardiovascular DiseasesAcute Ischemic Stroke Management

Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial

Taylor, D Wayne, Barnett, Henry JM, Haynes, R Brian, Ferguson, Gary G, Sackett, David L, Thorpe, Kevin E, Simard, Denis, Silver, Frank L +4 more·1999·The Lancet
DOI 10.1016/s0140-6736(99)05388-x
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Abstract

Background Endarterectomy benefits certain patients with carotid stenosis, but benefits are lessened by perioperative surgical risk. Acetylsalicylic acid lowers the risk of stroke in patients who have experienced transient ischaemic attack and stroke. We investigated appropriate doses and the role of acetylsalicylic acid in patients undergoing carotid endarterectomy.Methods In a randomised, double-blind, controlled trial, 2849 patients scheduled for endarterectomy were randomly assigned 81 mg (n=709), 325 mg (n=708), 650 mg (n=715), or 1300 mg (n=717) acetylsalicylic acid daily, started before surgery and continued for 3 months. We recorded occurrences of stroke, myocardial infarction, and death. We compared patients on the two higher doses of acetylsalicylic acid with patients on the two lower doses.Findings Surgery was cancelled in 45 patients, none were lost to follow-up by 30 days, and two were lost by 3 months. The combined rate of stroke, myocardial infarction, and death was lower in the low-dose groups than in the high-dose groups at 30 days (5.4 vs 7.0%, p=0.07) and at 3 months (6.2 vs 8.4%, p=0.03). In an efficacy analysis, which excluded patients taking 650 mg or more acetylsalicylic acid before randomisation, and patients randomised within 1 day of surgery, combined rates were 3.7% and 8.2%, respectively, at 30 days (p=0.002) and 4.2% and 10.0% at 3 months (p=0.0002).Interpretation The risk of stroke, myocardial infarction, and death within 30 days and 3 months of endarterectomy is lower for patients taking 81 mg or 325 mg acetylsalicylic acid daily than for those taking 650 mg or 1300 mg.

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Authors
Taylor, D. W., Barnett, H. J., Haynes, R. B., Ferguson, G. G., Sackett, D. L., Thorpe, K. E., Simard, D., Silver, F. L., Hachinski, V., Clagett, G. P., Barnes, R., & Spence, J. D.
Affiliations
  • McMaster University (CA)
  • Western University (CA)
  • University of Oxford (GB)
  • Hôpital de l'Enfant-Jésus (CA)
  • The University of Texas Southwestern Medical Center (US)
  • John L. McClellan Memorial Veterans Hospital (US)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
1999-06
Volume
353
Issue
9171
Pages
2179-2184
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(99)05388-x
OpenAlex
W2124840320
Cited by
530
References
24
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 7 · 2022: 13 · 2021: 10 · 2020: 9 · 2019: 9 · 2018: 11 · 2017: 12 · 2016: 14 · 2015: 20 · 2014: 9 · 2013: 19 · 2012: 20
FWCI
30.02
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01ns032832-03)
  • National Institute of Neurological Disorders and Stroke (R01-NS-32832-03)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Keywords
aspirin, carotid endarterectomy, carotid artery stenosis, antiplatelet therapy, aspirin dose, stroke prevention, myocardial infarction, postoperative mortality, perioperative risk
MeSH terms
Aged, Aspirin, Blood Pressure, Cerebrovascular Disorders, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Myocardial Infarction, Platelet Aggregation Inhibitors, Postoperative Period, Endarterectomy, Carotid

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