***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Of the 200 million adults worldwide who undergo noncardiac surgery each year , more than 1 million will die within 30 days . OBJECTIVE To determine the relationship between the peak fourth-generation troponin T ( TnT ) measurement in the first 3 days after noncardiac surgery and 30-day mortality . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve , international cohort study that enrolled patients from August 6 , 2007 , to January 11 , 2011 . Eligible patients were aged 45 years and older and required at least an overnight hospital admission after having noncardiac surgery . MAIN OUTCOME MEASURES Patients ' TnT levels were measured 6 to 12 hours after surgery and on days 1 , 2 , and 3 after surgery . We undertook Cox regression analysis in which the dependent variable was mortality until 30 days after surgery , and the independent variables included 24 preoperative variables . We repeated this analysis , adding the peak TnT measurement during the first 3 postoperative days as an independent variable and used a minimum P value approach to determine if there were TnT thresholds that independently altered patients ' risk of death . RESULTS A total of 15,133 patients were included in this study . The 30-day mortality rate was 1.9 % ( 95 % CI , 1.7%-2.1 % ) . Multivariable analysis demonstrated that peak TnT values of at least 0.02 ng/mL , occurring in 11.6 % of patients , were associated with higher 30-day mortality compared with the reference group ( peak TnT ≤ 0.01 ng/mL ) : peak TnT of 0.02 ng/mL ( adjusted hazard ratio [ aHR ] , 2.41 ; 95 % CI , 1.33 - 3.77 ) ; 0.03 to 0.29 ng/mL ( aHR , 5.00 ; 95 % CI , 3.72 - 6.76 ) ; and 0.30 ng/mL or greater ( aHR , 10.48 ; 95 % CI , 6.25 - 16.62 ) . Patients with a peak TnT value of 0.01 ng/mL or less , 0.02 , 0.03 - 0.29 , and 0.30 or greater had 30-day mortality rates of 1.0 % , 4.0 % , 9.3 % , and 16.9 % , respectively . Peak TnT measurement added incremental prognostic value to discriminate those likely to die within 30 days for the model with peak TnT measurement vs without ( C index = 0.85 vs 0.81 ; difference , 0.4 ; 95 % CI , 0.2 - 0.5 ; P < .001 for difference between C index values ) . The net reclassification improvement with TnT was 25.0 % ( P < .001 ) . CONCLUSION Among patients undergoing noncardiac surgery , the peak postoperative TnT measurement during the first 3 days after surgery was significantly associated with 30-day mortality Background — To identify patients at risk for postoperative myocardial injury and death , measuring cardiac troponin routinely after noncardiac surgery has been suggested . Such monitoring was implemented in our hospital . The aim of this study was to determine the predictive value of postoperative myocardial injury , as measured by troponin elevation , on 30-day mortality after noncardiac surgery . Methods and Results — This observational , single-center cohort study included 2232 consecutive intermediate- to high-risk noncardiac surgery patients aged ≥60 years who underwent surgery in 2011 .  Troponin was measured on the first 3 postoperative days . Log binomial regression analysis was used to estimate the association between postoperative myocardial injury ( troponin I level > 0.06 & mgr;g/L ) and all-cause 30-day mortality . Myocardial injury was found in 315 of 1627 patients in whom troponin I was measured ( 19 % ) . All-cause death occurred in 56 patients ( 3 % ) . The relative risk of a minor increase in troponin ( 0.07–0.59 & mgr;g/L ) was 2.4 ( 95 % confidence interval , 1.3–4.2 ; P<0.01 ) , and the relative risk of a 10- to 100-fold increase in troponin ( ≥0.60 & mgr;g/L ) was 4.2 ( 95 % confidence interval , 2.1–8.6 ; P<0.01 ) . A myocardial infa rct ion according to the universal definition was diagnosed in 10 patients ( 0.6 % ) , of whom 1 ( 0.06 % ) had ST-segment elevation myocardial infa rct ion . Conclusions — Postoperative myocardial injury is an independent predictor of 30-day mortality after noncardiac surgery . Implementation of postoperative troponin monitoring as st and ard of care is feasible and may be helpful in improving the prognosis of patients undergoing noncardiac surgery BACKGROUND Dual-antiplatelet therapy with aspirin and a thienopyridine is a cornerstone of treatment to prevent thrombotic complications of acute coronary syndromes and percutaneous coronary intervention . METHODS To compare prasugrel , a new thienopyridine , with clopidogrel , we r and omly assigned 13,608 patients with moderate-to-high-risk acute coronary syndromes with scheduled percutaneous coronary intervention to receive prasugrel ( a 60-mg loading dose and a 10-mg daily maintenance dose ) or clopidogrel ( a 300-mg loading dose and a 75-mg daily maintenance dose ) , for 6 to 15 months . The primary efficacy end point was death from cardiovascular causes , nonfatal myocardial infa rct ion , or nonfatal stroke . The key safety end point was major bleeding . RESULTS The primary efficacy end point occurred in 12.1 % of patients receiving clopidogrel and 9.9 % of patients receiving prasugrel ( hazard ratio for prasugrel vs. clopidogrel , 0.81 ; 95 % confidence interval [ CI ] , 0.73 to 0.90 ; P<0.001 ) . We also found significant reductions in the prasugrel group in the rates of myocardial infa rct ion ( 9.7 % for clopidogrel vs. 7.4 % for prasugrel ; P<0.001 ) , urgent target-vessel revascularization ( 3.7 % vs. 2.5 % ; P<0.001 ) , and stent thrombosis ( 2.4 % vs. 1.1 % ; P<0.001 ) . Major bleeding was observed in 2.4 % of patients receiving prasugrel and in 1.8 % of patients receiving clopidogrel ( hazard ratio , 1.32 ; 95 % CI , 1.03 to 1.68 ; P=0.03 ) . Also greater in the prasugrel group was the rate of life-threatening bleeding ( 1.4 % vs. 0.9 % ; P=0.01 ) , including nonfatal bleeding ( 1.1 % vs. 0.9 % ; hazard ratio , 1.25 ; P=0.23 ) and fatal bleeding ( 0.4 % vs. 0.1 % ; P=0.002 ) . CONCLUSIONS In patients with acute coronary syndromes with scheduled percutaneous coronary intervention , prasugrel therapy was associated with significantly reduced rates of ischemic events , including stent thrombosis , but with an increased risk of major bleeding , including fatal bleeding . Overall mortality did not differ significantly between treatment groups . ( Clinical Trials.gov number , NCT00097591 [ Clinical Trials.gov ] . OBJECTIVE The aim of this trial was to evaluate the bleeding after dental extraction s among patients on uninterrupted antiplatelet therapy . MATERIAL S AND METHODS A total of 190 patients under oral antiplatelet drugs requiring extraction of a single molar tooth were r and omly assigned to two groups . Group A consisted of 95 patients on uninterrupted antiplatelet therapy  and Group B consisted of 95 patients who have discontinued antiplatelet medication 5 days prior to extraction .  The bleeding time of all patients was checked prior to extraction . The surgical procedure involved simple extraction of a single molar tooth under local anesthesia . The extraction socket was sutured with 3 - 0 silk . Pressure pack with gauze was given for 1 h. Bleeding after 1 h , 24 h , 48 h , and 5 days were compared between two groups . Chi-square test was used to compare the variables . P < 0.05 was taken as significant . RESULTS None of the patients in either group had any significant uncontrollable bleeding after extraction . CONCLUSION Hence , we recommend routine single tooth extraction s in patients on long-term antiplatelet medication  , without interruption or alteration of their medication . Such patients do not have an increased risk of prolonged or excessive postoperative bleeding BACKGROUND Variation in and irreversibility of platelet inhibition with clopidogrel has led to controversy about its optimum dose and timing of administration in patients with acute coronary syndromes . We compared ticagrelor , a more potent reversible P2Y12 inhibitor with clopidogrel in such patients . METHODS At r and omisation , an invasive strategy was planned for 13 408 ( 72.0 % ) of 18 624 patients hospitalised for acute coronary syndromes ( with or without ST elevation ) . In a double-blind , double-dummy study , patients were r and omly assigned in a one-to-one ratio to ticagrelor and placebo ( 180 mg loading dose followed by 90 mg twice a day ) , or to clopidogrel and placebo ( 300 - 600 mg loading dose or continuation with maintenance dose followed by 75 mg per day ) for 6 - 12 months . All patients were given aspirin . The primary composite endpoint was cardiovascular death , myocardial infa rct ion , or stroke . Analyses were by intention to treat . This trial is registered with Clinical Trials.gov , number NCT00391872 . FINDINGS 6732 patients were assigned to ticagrelor and 6676 to clopidogrel . The primary composite endpoint occurred in fewer patients in the ticagrelor group than in the clopidogrel group ( 569 [ event rate at 360 days 9.0 % ] vs 668 [ 10.7 % ] , hazard ratio 0.84 , 95 % CI 0.75 - 0.94 ; p=0.0025 ) . There was no difference between clopidogrel and ticagrelor groups in the rates of total major bleeding ( 691 [ 11.6 % ] vs 689 [ 11.5 % ] , 0.99 [ 0.89 - 1.10 ] ; p=0.8803 ) or severe bleeding , as defined according to the Global Use of Strategies To Open occluded coronary arteries , ( 198 [ 3.2 % ] vs 185 [ 2.9 % ] , 0.91 [ 0.74 - 1.12 ] ; p=0.3785 ) . INTERPRETATION Ticagrelor seems to be a better option than clopidogrel for patients with acute coronary syndromes for whom an early invasive strategy is planned BACKGROUND There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery , both among patients who are already on an aspirin regimen and among those who are not . METHODS Using a 2-by-2 factorial trial design , we r and omly assigned 10,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo . The results of the aspirin trial are reported here . The patients were stratified according to whether they had not been taking aspirin before the study ( initiation stratum , with 5628 patients ) or they were already on an aspirin regimen ( continuation stratum , with 4382 patients ) . Patients started taking aspirin ( at a dose of 200 mg ) or placebo just before surgery and continued it daily ( at a dose of 100 mg ) for 30 days in the initiation stratum and for 7 days in the continuation stratum , after which patients resumed their regular aspirin regimen . The primary outcome was a composite of death or nonfatal myocardial infa rct ion at 30 days . RESULTS The primary outcome occurred in 351 of 4998 patients ( 7.0 % ) in the aspirin group and in 355 of 5012 patients ( 7.1 % ) in the placebo group ( hazard ratio in the aspirin group , 0.99 ; 95 % confidence interval [ CI ] , 0.86 to 1.15 ; P=0.92 ) . Major bleeding was more common in the aspirin group than in the placebo group ( 230 patients [ 4.6 % ] vs. 188 patients [ 3.8 % ] ; hazard ratio 
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Conclusion It was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer .