Abstract 12118: Risk of Thrombotic Events After Discontinuation of Aspirin in Perioperative Period in Patients With Established or at Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
Introduction: Aspirin for prolonged duration is commonly prescribed to patients with a history of cardiovascular events who are at continued risk for occlusive vascular events (secondary prevention). Patients in the peri-operative period are not only at an increased risk of bleeding but also for thrombotic vascular events because of the pro-thrombotic milieu. Hypothesis: The objective of our study was to do a systematic review and meta-analysis to compare the risk of thrombotic events and the risk of bleeding in patients with early (3-5 days) versus late discontinuation/no discontinuation of aspirin. Methods: PubMed and Embase were searched to identify the studies that report discontinuation or non-adherence of aspirin in patients undergoing surgery. The studies were included if they reported thrombotic events (stroke, all-cause mortality, MI, stent thrombosis & restenosis, stroke, heart failure, VTE, acute limb ischemia, perioperative cardiovascular complications) and perioperative bleeding. Odds ratio was calculated for the measured outcomes. The outcomes were pooled by generic inverse variance method in a random effects model and corresponding forest plots were made. Quality assessment was done as per Newcastle-Ottawa scale. Results: Our search strategy revealed 1018 studies out of which 6 observational studies (3 evaluating cardiac and 3 non-cardiac surgeries) met the inclusion criteria. There was no difference in the risk of thrombotic events both in early or late discontinuation of aspirin (OR 1.17, 95% CI= 0.74-1.84, p =0.50; I2 = 56%) (Figure 1). Early discontinuation of aspirin showed a decreased risk of peri-operative bleeding (OR 0.82, 95% CI= 0.67-0.99; p =0.04; I2 = 42%) (Figure 2). Conclusion: Planned discontinuation of aspirin is acceptable with no increased risk of thrombotic events and with a decreased risk of bleeding. Moreover the decreased risk of peri-operative complications may help reduce the length of stay and associated co-morbidities.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.035 |
| Bibliometrics | 0.008 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".