A randomised controlled trial to evaluate and optimize the use of antiplatelet agents in the perioperative management in patients undergoing general and abdominal surgery- the APAP trial (ISRCTN45810007)

This is a two-arm, monocenter randomised controlled trial. Patients scheduled for elective surgical treatment (i.e. inguinal hernia repair, cholecystectomy and colorectal resections) with ASA as a permanent medication are randomised equally to perioperative continuation or discontinuation of ASA. Patients who are randomised in the discontinuation group stop the administration of ASA five days prior to surgical treatment and start intake of ASA on postoperative day 5. Fifty-two patients will be enrolled in this trial. The primary outcome is the incidence of postoperative bleeding and cardiovascular events at 30 days after surgery. In addition a set of general as well as surgical variables are analysed.This is a randomised controlled two-group parallel trial designed to assess the safety and optimize the use of ASA in the perioperative management of patients undergoing general and abdominal surgery. The results of this pilot study build the basis for a confirmative randomised controlled trial that may help to clarify the use and potential risk/benefits of perioperative ASA medication in patients undergoing elective surgery.The trial is registered with Current Controlled Trials ISRCTN45810007.The individual risk for perioperative bleeding in abdominal and general surgery is influenced by multiple factors. Such factors include extent and type of surgery as well as patient-related features such as age, co-morbidities and perioperative medication. Considering the current demographic development surgeons are being confronted with older patients presenting with multiple co-morbidities and medications. Antiplatelet agents and in particular acetylsalicylic acid (ASA) were shown to be beneficial in a variety of atherothrombotic diseases [1-4] and are therefore among the most frequently prescribed drugs these days. However, due to the increased risk of hemorrhage the perioperative use of ASA has remained an issue of ongoing discussion [5-13].Randomised controlled trials (RCT) t