Hacked by the Russians
2018; Elsevier BV; Volume: 157; Issue: 2 Linguagem: Inglês
10.1016/j.jtcvs.2018.10.025
ISSN1097-685X
Autores Tópico(s)Cardiac and Coronary Surgery Techniques
ResumoCentral MessageWe have to stick to our data and only present them with the highest quality of methodology. We do not write in grocery magazines.See Article page 633. We have to stick to our data and only present them with the highest quality of methodology. We do not write in grocery magazines. See Article page 633. Hacked by the Russians: That was my first reaction when I was asked to review 2 Aspirin and Tranexamic Acid for Coronary Artery Surgery trials for the Journal. I thought the Journal had been hacked or I was reading fake news. The Aspirin and Tranexamic Acid for Coronary Artery Surgery trial (tranexamic acid vs placebo and acetylsalicylic acid vs placebo in a factorial design) is a great trial that produced 2 factual and honest articles published in The New England Journal of Medicine.1Myles P.S. Smith J.A. Forbes A. Silbert B. Jayarajah M. Painter T. et al.ATACAS Investigators of the ANZCA Clinical Trials NetworkTranexamic acid in patients undergoing coronary-artery surgery.N Engl J Med. 2017; 376: 136-148Crossref PubMed Scopus (197) Google Scholar, 2Myles P.S. Smith J.A. Forbes A. Silbert B. Jayarajah M. Painter T. et al.ATACAS Investigators of the ANZCA Clinical Trials NetworkStopping vs. continuing aspirin before coronary artery surgery.N Engl J Med. 2016; 374: 728-737Crossref PubMed Scopus (129) Google Scholar No differences in mortality or myocardial infarction (MI) were observed. The same authors are now suggesting that tranexamic acid may reduce major adverse cardiovascular events (MACE) at 1 year (with a P value of .053) and a skimpy meta-analysis showing a reduced rate of MI? How is this possible? Please try to explain to me how a prothrombotic drug (by stabilizing fibrin clots) could improve survival and decrease MI at 1 year. What is the mechanism? By making more clots? Keep in mind that a large trial3Eikelboom J.W. Connolly S.J. Bosch J. Dagenais G.R. Hart R.G. Shestakovska O. et al.COMPASS InvestigatorsRivaroxaban with or without aspirin in stable cardiovascular disease.N Engl J Med. 2017; 377: 1319-1330Crossref PubMed Scopus (1389) Google Scholar of 27,000 patients just demonstrated that a low dose of antithrombotic medication (rivaroxaban) demonstrated a very significant reduction in MACE (death, MI, and stroke) in patients with coronary artery disease. You will tell me to let the readers decide for themselves. We are supposed to read the whole article, but most of us only read the title and the conclusion of the abstract, and then if really interested, we will read the whole article. I know you do this as well. There is a reason why people still buy grocery magazines. Therefore, it is crucial the title, the abstract, and the article represent the data with correct methodology, without trying to sell something or misrepresenting the scientific message. Flashy conclusions and hypotheses have no place in an article. If you have a brilliant hypothesis, just disclose it properly in the Discussion section by mentioning “a trend in improving MACE at 1 year has been observed, possibly explained by avoiding blood products at time of surgery. The mechanism remains unclear, but this hypothesis need to be resolved with further research.” It is time that authors put their egos in the closet, avoid over-the-top conclusions, and stick to respected methodology, even if the results are not as expected.4Lamy A. Devereaux P.J. Prabhakaran D. Taggart D.P. Hu S. Straka Z. et al.CORONARY InvestigatorsOff-pump or on-pump coronary-artery bypass grafting at 30 days.N Engl J Med. 2012; 366: 1489-1497Crossref PubMed Scopus (526) Google Scholar Surgeons are not stupid, but we act like it when we are willing to accept flashy conclusions too quickly, without examining the data but also accepting inaccurate and erroneous articles in our surgical journals. We surgeons, and reviewers and editors as well, need to stick to the facts and demand the highest quality. The authors, reviewers, and editors of The New England Journal of Medicine do it, and this Journal should do it too. I would like to finish with the words of Bruce Springsteen, a great American songwriter and rocker: “Trust none of what you hear and less of what you see.”5Springsteen B. Magic. Columbia Records, New York, NY2007Google Scholar Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trialThe Journal of Thoracic and Cardiovascular SurgeryVol. 157Issue 2PreviewAspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Full-Text PDF Open ArchiveAccurate reporting of clinical trialsThe Journal of Thoracic and Cardiovascular SurgeryVol. 158Issue 2PreviewWe were surprised to read Dr Lamy's Editorial Commentary,1 in which he describes his first reaction (“I was reading fake news”) when asked to review our manuscripts reporting the 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial.2,3 We wish to reassure readers of the Journal that the content of these articles accurately represents the work undertaken and the observed results. It is disappointing that Dr Lamy does not encourage readers to read the entire article, in which the answers to his queries can be found. Full-Text PDF Open Archive
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