Antiplatelet Therapy, Abdominal Aortic Aneurysm Progression, and Clinical Outcomes

This cohort study evaluates the association of acetylsalicylic acid use with aneurysm progression and long-term clinical outcomes in patients with abdominal aortic aneurysm.


BARC (Bleeding Academic Research Consortium) Definition
Type 1: bleeding that is not actionable and does not cause the patient to seek an unscheduled performance of studies, hospitalization, or treatment by a health care professional; it may include episodes leading to self-discontinuation of medical therapy by the patient without consulting a health care professional.
Type 2: any overt, actionable sign of hemorrhage (e.g., more bleeding than would be expected for a clinical circumstance, including bleeding found by imaging alone) that does not fit the criteria for type 3, type 4, or type 5 but does meet at least one of the following criteria: requiring nonsurgical, medical intervention by a health care professional; leading to hospitalization or increased level of care; or prompting evaluation.
Type 3a: overt bleeding plus a hemoglobin drop of 3 to 5 g/dL* (provided the hemoglobin drop is related to bleed); any transfusion with overt bleeding.
Type 3b: overt bleeding plus a hemoglobin drop of 5 g/dL (provided the hemoglobin drop is related to bleed); cardiac tamponade; bleeding requiring surgical intervention for control (excluding dental, nasal, skin, and hemorrhoid); bleeding requiring intravenous vasoactive agents.
Type 3c: intracranial hemorrhage (does not include microbleeds or hemorrhagic transformation, does include intraspinal); subcategories confirmed by autopsy or imaging, or lumbar puncture; intraocular bleed compromising vision.
Type 4: coronary artery bypass grafting-related bleeding; perioperative intracranial bleeding within 48 hours; reoperation after closure of sternotomy for the purpose of controlling bleeding; transfusion of 5 U of whole blood or packed red blood cells within a 48-hour period; chest tube output 2 L within a 24-hour period.
Type 5a: probable fatal bleeding; no autopsy or imaging confirmation but clinically suspicious.
Type 5b: definite fatal bleeding; overt bleeding or autopsy, or imaging confirmation.
eFigure Legends eFigure 1. Title: Love plot for covariate balance in the 1:1 propensity matched group of aspirin and nonaspirin users.

Caption:
We performed 1:1 propensity matching for aspirin and non-aspirin users according to demographic and clinical baseline characteristics as well as baseline diameter, and we achieved a balanced covariate balance depicted on the Love plot here, with an absolute standardized mean difference between -0.1 and 0.1.eFigure 2. Title: Kaplan-Meier curves of the cumulative incidence of study outcomes in a 1:1 propensitymatched cohort.
Caption: (A) all-cause mortality, composite of aneurysm repair, rupture, or dissection (B) and (C) Major bleeding.In a 1:1 propensity matched group of patients, there was not significant difference in the risk of all-cause mortality or composite of aneurysm repair, rupture, or dissection according to aspirin use.We performed 1:1 propensity matching for aspirin and non-aspirin users according to demographic and clinical baseline characteristics as well as baseline diameter, and we achieved a balanced covariate balance depicted on the Love plot here, with an absolute standardized mean difference between -0.1 and 0.1.

eTable 2. Univariate and Multivariable-Adjusted Regression Analyses of All-Cause Mortality and Composite of Aneurysm Repair, Dissection, or Rupture, According to Aspirin Use Unadjusted Multivariable adjusted
Cox proportional hazards model was used.For the composite outcome, competing risks model was used with mortality as the competing event.†.

Univariate and Multivariable Linear Regression Analyses for the Annualized Change Abdominal Aortic Aneurysm Diameter According to Antiplatelet Use Mean annualized change in mm/year (SD) Unadjusted Multivariable adjusted †
© 2023 Hariri E et al.JAMA Network Open.