Testing heart medications post-surgery to prevent complications and improve recovery in older adults

Associate Professor Jonathon Fanning, The University of Queensland

Vanguard Grant - 1 Year

Years funded: 2025 - 2025

Reducing the incidence of major adverse cardiovascular events following myocardial injury in non-cardiac surgery

Perioperative myocardial infarction is a leading cause of morbidity and mortality, accounting for a third of all perioperative deaths. However, clinically apparent events represent <20% of heart injuries, with many more patients sustaining subclinical myocardial injuries. Despite this, optimal management of myocardial injury in non-cardiac surgery (MINS) remains uncertain. This pilot feasibility study will inform the development of a larger randomised controlled trial aimed at improving post-surgical patient outcomes with: 1) the daily use of clopidogrel (75 mg) + aspirin (100 mg); and, 2) dapagliflozin (10 mg) by reducing the incidence of major adverse cardiovascular events following MINS.

This randomised pilot study will be set up and conducted initially at two (already funded) sites: The Prince Charles Hospital and Princess Alexandra Hospital in Brisbane, Queensland, Australia. This application will extend the to two inter-state sites (Royal Perth and Royal North Shore Hospital) to ensure sufficient diversity and adequate power to test the feasibility of the larger study protocol. Following a 1-month site setup period, the pilot will run until 25 patients are recruited at each of the 4 hospital sites and have been followed up for 6 months. Eligible participants will be ≥ 45 years old, at intermediate or high perioperative cardiovascular risk, who have undergone major non-cardiac surgery and have been identified by routine troponin screening to have suffered MINS. Troponin levels will be screened as per the Clinical Practice Guidelines published by the European Society of Cardiology, which will involve troponins taken pre-surgery and at 24-hour, and 48 hours- postoperatively.

The study will enrol participants to a factor-dependent schedule of 6 months of study drug and follow-up. The information obtained from this pilot will be used to optimise the protocol for the definitive trial, and feasibility will be decided based on quantitative progression criteria. To avoid “reverse-multiplicity” we will use a formal hypothesis testing approach for feasibility based on recruitment, follow-up, and adherence rates for each Factor (DAPT and SGLT2).