Evaluation of Aspirin and Tranexamic Acid in Coronary Artery Surgery: The ATACAS Trial

这项大型研究将对4600名接受心脏手术的患者进行两种药物治疗的比较，看看其中一种能否降低死亡或重大并发症的风险。我们测量的术后并发症包括心脏病发作、中风、肺栓塞、心脏周围出血、呼吸衰竭、肾功能衰竭、大出血、严重伤口感染和死亡。第一种被测试的药物是低剂量的阿司匹林。据信，阿司匹林可以降低既往心脏病患者进一步心脏病发作或中风的风险。有一些证据表明，阿司匹林对接受心脏手术的人可能有类似的效果，但由于担心手术后出血的风险可能会增加，这种使用受到限制。出于这个原因，大多数接受心脏手术的患者被建议在手术前大约一周停止服用阿司匹林。但患者可能会错过阿司匹林的有益作用。目前，我们不知道阿司匹林的益处是否会超过过度出血的风险。第二种接受测试的药物是氨甲环酸。这种药物可以防止血液凝块在手术缝合部位被分解，并可能减少心脏手术中和手术后的失血量。众所周知，使用这种药物可以减少输血的需要。这可能会避免手术后出现其他更严重的并发症。这两种药物都在单独进行测试，但除此之外，我们还在测试它们联合使用时是否会产生额外的有益效果。这项研究是由澳大利亚20多家医院的麻醉师和外科医生合作完成的。

This large study will compare two types of drug treatment in 4600 patients undergoing heart surgery, to see whether either can reduce the risk of death or major complications. The complications after surgery we are measuring include heart attack, stroke, lung embolism, bleeding around the heart, breathing failure, kidney failure, major haemorrhage, serious wound infection, and death. The first drug being tested is low-dose aspirin. It is believed that aspirin can reduce the risk of a further heart attack or stroke in patients with pre-existing heart disease. There is some evidence that aspirin may have similar effects in people undergoing heart surgery, but such use is constrained by a concern that there may be an increased risk of bleeding after surgery. For this reason, most patients having heart surgery are advised to stop their aspirin about one week before surgery. But patients could be missing out on aspirin's beneficial effects. At present, we do not know whether the benefits of aspirin could outweigh the risk of excesive bleeding. The second drug being tested is tranexamic acid. This drug prevents blood clot being broken down at the stitching sites of surgery, and probably reduces the amount of blood loss during and after heart surgery. It is known that use of this drug reduces the need for a blood transfusion. It is possible that this could avoid other more serious complications after surgery. Both of these drugs are being tested individually, but in addition we are testing whether they may have an extra beneficial effect when used together. The study is being done by a partnership of anaesthetitsts and surgeons at more than 20 hospitals around Australia.