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Comment & Response |

Perioperative Treatment With Aspirin or Clonidine and Risk of Acute Kidney Injury—Reply

P. J. Devereaux, MD, PhD1; Daniel I. Sessler, MD2; Amit X. Garg, MD, PhD3 ; for the POISE-2 Investigators
[+] Author Affiliations
1Population Health Research Institute, Hamilton, Ontario, Canada
2Cleveland Clinic, Cleveland, Ohio
3Western University, London, Ontario, Canada
JAMA. 2015;313(11):1166-1167. doi:10.1001/jama.2015.1061.
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In Reply Drs Sun and Liu are concerned that the risk of major bleeding in POISE-2 (ie, 3.8% in the aspirin placebo group) does not reflect the real-world experience because a study that used the NSQIP database reported a 0.8% risk of major perioperative bleeding.1 There were, however, substantial differences in the populations and bleeding definitions between these studies.

The POISE-2 study included older patients (≥45 years) than in the study using the NSQIP database (≥18 years) and they were at higher risk of bleeding (ie, including [vs excluding] patients undergoing trauma, transplant, and emergent surgery). POISE-2 also had a more inclusive definition of major bleeding (ie, bleeding that only required 2 U of blood vs 4 U of blood). We therefore, not surprisingly, reported a higher incidence of bleeding.


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March 17, 2015
Jianzhong Sun, MD, PhD; Hong Liu, MD
1Department of Anesthesiology, Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania
2Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, Sacramento
JAMA. 2015;313(11):1166. doi:10.1001/jama.2015.1055.
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