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Thorac Cardiovasc Surg 2013; 61(08): 726-730
DOI: 10.1055/s-0032-1328927
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Continuing Aspirin Causes Higher Drainage Even under Full Protection with Antifibrinolytics

Adil A. M. Al-Lawati
1   Department of Cardiothoracic Surgery, Royal Hospital, Muscat, Oman
,
Venkatraman Muthuswamy
1   Department of Cardiothoracic Surgery, Royal Hospital, Muscat, Oman
› Author Affiliations
Further Information

Publication History

16 June 2012

13 August 2012

Publication Date:
23 January 2013 (online)

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Abstract

Background The purpose of this study was to assess the impact of continuation of aspirin on bleeding complications following coronary artery bypass grafting (CABG) surgery operated by a single surgeon.

Methods A total of 109 patients underwent isolated, primary, on-pump surgery performed over a 17-month period. These patients were divided into two groups: group 1 (n = 51) received aspirin (81 mg daily) to within 7 days of surgery and group 2 (n = 58) in which aspirin was discontinued > 7 days before surgery. All patients received antifibrinolytic agents. Both groups had identical preoperative characteristics.

Results The aspirin group had significant more drainage and consumed more blood products than the nonaspirin group during the first 12 postoperative hours. However, both groups were similar in terms of: (1) re-exploration rate, (2) requirements for blood transfusion, (3) drop in hemoglobin levels and platelet counts, and (4) length of intensive care unit and hospital stay.

Conclusion Continuing aspirin before CABG is associated with increased blood loss even when used in small doses and under full cover of antifibrinolytic agents. However, this blood loss is not harmful and does not negatively affect the patient's clinical progress.

Keywords

cardiac - coronary artery bypass grafts surgery - CABG - surgery - complications
 

  • References

  • 1 Goldman S, Copeland J, Moritz T , et al; Department of Veterans Affairs Cooperative Study Group. Starting aspirin therapy after operation. Effects on early graft patency. Circulation 1991; 84 (2) 520-526
    CrossrefPubMedGoogle Scholar
  • 2 Hillis LD, Smith PK, Anderson JL , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2012; 143 (1) 4-34
    CrossrefPubMedGoogle Scholar
  • 3 Dacey LJ, Munoz JJ, Johnson ER , et al; Northern New England Cardiovascular Disease Study Group. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients. Ann Thorac Surg 2000; 70 (6) 1986-1990
    CrossrefPubMedGoogle Scholar
  • 4 Bybee KA, Powell BD, Valeti U , et al. Preoperative aspirin therapy is associated with improved postoperative outcomes in patients undergoing coronary artery bypass grafting. Circulation 2005; 112 (9, Suppl) I286-I292
    PubMedGoogle Scholar
  • 5 Tuman KJ, McCarthy RJ, O'Connor CJ, McCarthy WE, Ivankovich AD. Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery. Anesth Analg 1996; 83 (6) 1178-1184
    PubMedGoogle Scholar
  • 6 Sun JCJ, Crowther MA, Warkentin TE, Lamy A, Teoh KH. Should aspirin be discontinued before coronary artery bypass surgery?. Circulation 2005; 112 (7) e85-e90
    CrossrefPubMedGoogle Scholar
  • 7 Ghaffarinejad MH, Fazelifar AF, Shirvani SM , et al. Effect of preoperative aspirin use on postoperative bleeding and perioperative myocardial infarction in patients undergoing coronary artery bypass surgery. Iranian Heart J 2008; 9 (2) 18-22
    PubMedGoogle Scholar
  • 8 Alghamdi AA, Moussa F, Fremes SE. Does the use of preoperative aspirin increase the risk of bleeding in patients undergoing coronary artery bypass grafting surgery? Systematic review and meta-analysis. J Card Surg 2007; 22 (3) 247-256
    CrossrefPubMedGoogle Scholar
  • 9 Sun JCJ, Whitlock R, Cheng J , et al. The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies. Eur Heart J 2008; 29 (8) 1057-1071
    CrossrefPubMedGoogle Scholar
  • 10 Mehta RH, Sheng S, O'Brien SM , et al; Society of Thoracic Surgeons National Cardiac Surgery Database Investigators. Reoperation for bleeding in patients undergoing coronary artery bypass surgery: incidence, risk factors, time trends, and outcomes. Circ Cardiovasc Qual Outcomes 2009; 2 (6) 583-590
    CrossrefPubMedGoogle Scholar
  • 11 Sethi GK, Copeland JG, Goldman S, Moritz T, Zadina K, Henderson WG. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. J Am Coll Cardiol 1990; 15 (1) 15-20
    CrossrefPubMedGoogle Scholar
  • 12 Kallis P, Tooze JA, Talbot S, Cowans D, Bevan DH, Treasure T. Pre-operative aspirin decreases platelet aggregation and increases post-operative blood loss—a prospective, randomised, placebo controlled, double-blind clinical trial in 100 patients with chronic stable angina. Eur J Cardiothorac Surg 1994; 8 (8) 404-409
    CrossrefPubMedGoogle Scholar
  • 13 Taggart DP, Siddiqui A, Wheatley DJ. Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements. Ann Thorac Surg 1990; 50 (3) 424-428
    PubMedGoogle Scholar
  • 14 Daily PO, Lamphere JA, Dembitsky WP, Adamson RM, Dans NF. Effect of prophylactic epsilon-aminocaproic acid on blood loss and transfusion requirements in patients undergoing first-time coronary artery bypass grafting. A randomized, prospective, double-blind study. J Thorac Cardiovasc Surg 1994; 108 (1) 99-106 , discussion 106–108
    PubMedGoogle Scholar
  • 15 Henry DA, Moxey AJ, Carless PA , et al; Cochrane Injuries Group. Anti-fibrinolytic use for minimizing perioperative allogeneic blood transfusion. Cochrane Database Syst Rev 2003;
    PubMedGoogle Scholar
  • 16 Pleym H, Stenseth R, Wahba A, Bjella L, Karevold A, Dale O. Single-dose tranexamic acid reduces postoperative bleeding after coronary surgery in patients treated with aspirin until surgery. Anesth Analg 2003; 96 (4) 923-928
    PubMedGoogle Scholar
  • 17 Brown JR, Birkmeyer NJ, O'Connor GT. Meta-analysis comparing the effectiveness and adverse outcomes of antifibrinolytic agents in cardiac surgery. Circulation 2007; 115 (22) 2801-2813
    CrossrefPubMedGoogle Scholar
  • 18 McIlroy DR, Myles PS, Phillips LE, Smith JA. Antifibrinolytics in cardiac surgical patients receiving aspirin: a systematic review and meta-analysis. Br J Anaesth 2009; 102 (2) 168-178
    CrossrefPubMedGoogle Scholar
  • 19 Fiechtner BK, Nuttall GA, Johnson ME , et al. Plasma tranexamic acid concentrations during cardiopulmonary bypass. Anesth Analg 2001; 92 (5) 1131-1136
    PubMedGoogle Scholar
  • 20 Tranexamic acid - DRUGDEX® Evaluations - MICROMEDEX® Healthcare Series. Thomson Healthcare 2008;
    PubMedGoogle Scholar
  • 21 Zimmermann N, Gams E, Hohlfeld T. Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent. Eur J Cardiothorac Surg 2008; 34 (1) 93-108
    CrossrefPubMedGoogle Scholar
  • 22 Cannon CP, Mehta SR, Aranki SF. Balancing the benefit and risk of oral antiplatelet agents in coronary artery bypass surgery. Ann Thorac Surg 2005; 80 (2) 768-779
    CrossrefPubMedGoogle Scholar
  • 23 Ferraris VA, Ferraris SP, Moliterno DJ , et al; Society of Thoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: aspirin and other antiplatelet agents during operative coronary revascularization (executive summary). Ann Thorac Surg 2005; 79 (4) 1454-1461
    CrossrefPubMedGoogle Scholar