Tuesday, 30 May 2017

A great day for Australian medical research

The Australian Clinical Trials Alliance (ACTA) recently presented its 2017 Trial of the Year Award to Professor Paul Myles and co-investigators on the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. The award was handed to Professor Myles by Minister for Health Greg Hunt MP.
The award ceremony also marked an important occasion for ACTA as the Minister used the event to announce $5 million over four years for the alliance from the Medical Research Future Fund. This was welcome endorsement of the vital role clinical trials networks play in facilitating evidence based practice. In addition to the ACTA funding, the Minister also announced $13 million of competitive grant funding and $8 million towards supporting new NHMRC research fellowship positions.

The ATACAS trial ran for 10 years and involved 4,660 participants across Australia, New Zealand, Asia and Europe. It is the largest study exploring aspirin and tranexamic acid use in cardiac surgery patients to date. The trial was led by the Australian and New Zealand College of Anaesthetists Clinical Trials Network and coordinated via SPHPM’s Centre of Cardiovascular Research & Education in Therapeutics and Alfred Health.

Coronary artery disease is caused by a build-up of waxy plaque on the inside of blood vessels that supply oxygen-rich blood to the heart. Over time the plaque can harden or break off and float away, blocking blood flow and potentially causing heart attack or stroke.

People with this condition are often prescribed long-term aspirin to prevent this. If the condition progresses to the point where aspirin is not sufficient to manage the risk, coronary artery bypass graft (CABG) surgery may be performed.

When the trial launched in 2008 there were concerns that whilst aspirin was good at reducing the risk of heart attack or stroke, it may lead to excessive bleeding after surgery. On the other hand, anti-fibrinolytic drugs such as tranexamic acid were known to reduce excessive bleeding, but could increase the chance of heart attack or stroke. There was a lack of agreement as to how to manage medications as the time of surgery approached.

In a series of papers published in the New England Journal of Medicine, the researchers found that it is safe to continue aspirin prior to surgery and this may be a safe and effective way to manage blood clotting risks. They also found tranexamic acid to be a safe and effective way to reduce the risk of bleeding complications without increasing the risk of heart attack or stroke.

Our congratulations go to ACTA, Professor Myles and his team. Professor Myles works in both the Monash Central Clinical School and the School of Public Health and Preventive Medicine.

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