A Meta-Analysis of Randomized and Observational Studies: Aspirin Protects from Cardiac Surgery-Associated Acute Kidney Injury

Abstract

<jats:p>Background: Antiplatelet therapy is critical in the management of coronary artery diseases. For patients undergoing cardiac surgeries, including coronary artery bypass graft (CABG) and valve replacement, controversy remains in preoperative antiplatelet therapy concerning risk of bleeding. For safety concern, aspirin is recommended to be withdrawn 5 to 10 days before a cardiac surgery. Recent studies, however, indicate that preoperative aspirin may have a protective effect on cardiac surgery-associated acute kidney injury (CSA-AKI).&#x0D; Objective: To estimate the efficacy of preoperative aspirin in preventing CSA-AKI.&#x0D; Methods and results: Eligible studies included randomized controlled trials (RCTs) and observational studies (OSs) of patients, who had undergone CABG, valve replacement, or combined surgery. These studies compared preoperative aspirin with placebo/no aspirin and reported the least incidence of CSA-AKI. One RCT and five OSs met the inclusion criteria. Data retrieved suggested that aspirin prescribed within five days before cardiac surgery decreased post-operative renal failure [odds ratio (OR), 0.67; 95% confidence interval (CI), 0.50-0.89; P &lt; 0.01] and 30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P &lt; 0.01). One RCT and three OSs suggested aspirin protected from major adverse cardiocerebral events (MACE) (OR, 0.88; 95% CI, 0.76-1.01; P = 0.07). One RCT and two OSs suggested aspirin did not increase risk of re-exploration for bleeding (OR, 1.01; 95% CI, 0.76-1.34; P = 0.95). &#x0D; Conclusion: Preoperative low-dose aspirin decreases post-operative CSA-AKI, mortality, and MACE without increasing the risk of re-exploration. But most of the studies are observational. They lack a uniformed standard on prescription of aspirin and outcomes measurement. No stratification analysis is performed concerning different types of surgical procedures and comorbidities. More randomized controlled trials are necessary to confirm the efficacy and safety of preoperative aspirin prescription.</jats:p>

Metformin use is associated with reduced acute kidney injury following coronary artery bypass grafting in patients with type 2 diabetes: An inverse probability of treatment weighting analysis

“…Recent studies have reported the impact of commonly used medications on AKI after cardiac surgery. A meta‐analysis 24 revealed that low‐dose aspirin has a protective effect on AKI after cardiac surgery without increasing the risk of bleeding. Additionally, several studies have shown that preoperative use of ACE inhibitor/ARB is associated with a higher risk of AKI postoperatively, and discontinuing these medications before cardiac surgery may reduce the incidence of AKI 25–27 .…”

Aspirin intervention before ICU admission reduced the mortality in critically ill patients with acute kidney injury: Results From the MIMIC-IV

“…In the present study, the amount of patients with AKI stage 2-3 in the aspirin group were fewer than that in the non-aspirin group (stage 2-3: 76.8% VS 80.4%), suggesting that aspirin did not exacerbate AKI. Rather, aspirin may improve renal perfusion through inhibiting thromboxane, antiplatelet aggregation, and reducing microembolism [18], and it has been demonstrated to reduce the risk of postoperative CSA-AKI and mortality in cardiac surgery patients [14].…”

“…Moreover, aspirin was found to alleviate proteinuria, hematuria, and improve renal function in the patients with progressive IgA nephropathy [11]. Aspirin intervention before cardiac surgery have been demonstrated to reduce cardiac surgery-associated acute kidney injury (CSA-AKI), major adverse cardiac, and cerebral events (MACE) with a reduced mortality [12][13][14]. However, aspirin intervention may increase the risk of major bleeding.…”

Persistent Pain After Cardiac Surgery: Prevention and Management

“…Furthermore, the use of non-ASA NSAIDs for cardiac surgical patients has been associated with acute kidney injury, 89 whereas ASA use has been shown to be protective. 90 Acetaminophen or paracetamol is a known cyclooxygenase (COX) inhibitor, although it does not exert its effect through peripheral inhibition of this enzyme as the non-steroid anti-inflammatory class of medications. 91 There is evidence that it inhibits COX centrally and acts through other non-COX mechanisms as well.…”

“…Furthermore, the use of non-ASA NSAIDs for cardiac surgical patients has been associated with acute kidney injury, 89 whereas ASA use has been shown to be protective. 90 …”