Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) Trial: Rationale and design

• Published in: The American heart journal Vol. 155; no. 2; pp. 224 - 230
• Main Authors: Myles, Paul S., MPH, MD, Smith, Julian, MS, Knight, John, MBBS, Cooper, D. James, MD, Silbert, Brendan, MBBS, McNeil, John, PhD, Esmore, Donald S., MBBS, Buxton, Brian, MD, Krum, Henry, PhD, Forbes, Andrew, PhD, Tonkin, Andrew, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2008; Elsevier; Elsevier Limited
• Subjects: Antifibrinolytic Agents - adverse effects; Antifibrinolytic Agents - therapeutic use; Aspirin - adverse effects; Aspirin - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary Artery Bypass; Coronary vessels; Drug therapy; Epidemiologic Research Design; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Heart attacks; Humans; Medical sciences; Mortality; Practice Guidelines as Topic; Tranexamic Acid - adverse effects; Tranexamic Acid - therapeutic use; Design; Treatment; Surgery; Coronary artery; Tranexamic acid; Acetylsalicylic acid; Circulatory system; Cardiology; Phlebology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2007.10.003

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.