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Evevident
Original paper
2014NEJMSurgery/Perioperative

POISE-2

Aspirin and clonidine in patients undergoing noncardiac surgery

RCTPerioperative medicine

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Overview

Perioperative aspirin and clonidine did not prevent death or MI; aspirin increased bleeding.

Clinical takeaway

POISE-2 is the companion perioperative caution trial to POISE: routine perioperative aspirin or clonidine initiation does not improve major ischemic outcomes and can cause harm.

Key result

Aspirin did not reduce death or nonfatal MI and increased major bleeding.

Practice impact

Avoid routine perioperative aspirin or clonidine solely to prevent MI in noncardiac surgery.

Evidence

Study design

Large randomized factorial perioperative trial.

Enrollment

10,010

Follow-up

30 days.

Geography

Multinational

Clinical question

Do aspirin or clonidine reduce death or nonfatal MI in patients undergoing noncardiac surgery?

Population

  • Patients undergoing noncardiac surgery at risk for vascular complications.

Intervention

Perioperative aspirin or clonidine strategies.

Comparator

Placebo.

Primary outcome

Composite of death or nonfatal myocardial infarction at 30 days.

Perioperative aspirin did not reduce death or nonfatal MI and increased major bleeding.

Hazard ratio / 0.99 / CI 95% CI 0.86-1.15 / p=0.92

Key results

  • Aspirin did not reduce death or nonfatal MI.
  • Aspirin increased major bleeding.
  • Clonidine did not reduce death or nonfatal MI and increased clinically important hypotension.

Harms

  • Aspirin increased major bleeding.
  • Clonidine increased clinically important hypotension and nonfatal cardiac arrest.

Clinical Use

When to cite

  • When deciding whether to start aspirin or clonidine around noncardiac surgery solely for perioperative cardioprotection.

Practice impact

  • Discouraged routine perioperative aspirin or clonidine initiation for ischemic prevention in noncardiac surgery.

Applicability

  • Adults undergoing noncardiac surgery where perioperative aspirin or clonidine is being considered for event prevention.

Limitations

  • Does not override separate indications for continuing aspirin in selected high-risk stent or vascular patients.
  • The card summarizes two linked POISE-2 randomized comparisons.

Common misinterpretations

  • Do not stop all chronic aspirin automatically; balance bleeding risk against the reason aspirin was prescribed.

Related evidence

POISE - Similar QuestionBRIDGE - Context

Citation

Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494-1503. doi:10.1056/NEJMoa1401105