Aspirin- and Coumadin®-Related Bleeding After Coronary-Artery Bypass Graft Surgery

Abstract

We studied 100 consecutive patients to evaluate the potential effect of platelet active and antithrombotic agents prescribed preoperatively on bleeding complications after coronary-artery bypass graft surgery. Preoperative hemostatic values were normal in all patients. Mean mediastinal blood loss was significantly greater in 13 patients taking aspirin (892 +/- 91 ml) and six patients taking Coumadin (warfarin sodium) (858 +/- 168 ml) within 7 days of surgery than in 64 control subjects (439 +/- 28, P less than 0.001). Less marked but similar differences (P less than 0.05) were noted with other agents inhibiting platelet function. However, in nine patients given heparin, mean mediastinal blood loss (436 +/- 61 ml) was no different from that of control subjects. The degree of mediastinal blood loss did not correlate with age, sex, mean total operative time, bypass time, or number of vessels diseased or bypassed. In addition, patients taking aspirin or Coumadin required prolonged chest tube drainage compared to those in heparin or control groups (34 +/- 4 versus 20 +/- 1 h) (P less than 0.001).

Does Short-Term Pre-Operative Aspirin in Coronary Bypass Patients Increase Post-Operative Bleeding?

“…However, the drugs, doses and duration of therapy were highly varied in this group of patients . 7 In the prospective randomized trial comparing aspirin and dypridamole vs. placebo by Chesebro, et al no significant differences were noted in chest tube blood loss, units of red cells transfused, transfusions of fresh frozen plasma and platelets, or the incidence of re-operation for bleeding. They concluded that dypridamole could be given safely pre-operatively and aspirin in the early post-operative period .…”

Assessment of Effects of Antiplatelet Drugs on Bleeding Risk After Teeth Extractions

“…literature showed that most of the authorities were in favour of stopping ASA therapy (4,9,12,18,24). however, several authors reported that most minor oral surgeries can be carried out safely without stopping long-term low-dose ASA regimen (3,15).…”

“…Although, low doses of ASA can prevent cardiovascular disease outcomes, also the risk for bleeding after dental extraction may be increased. original recommendations had been made for the discontinuation of ASA use for 7 to 10 days prior to surgical procedures (4,9,18,22,24). More recently, it was discussed that ASA can be discontinued for 3 days, which would ensure that a sufficient number of new platelets are released into the circulation.…”

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion

“…In the limited experience with preoperative administration of ticlopidine there was no beneficial effect on patency rate' 201 ; however, the incidence of perioperative infarctions was significantly reduced' 21 '. In this regard it is of interest, that aspirin, which prolongs bleeding time like ticlopidine, has been reported to increase the risk of postoperative bleeding ' 29 '. This drug was withheld before surgery in clinical trials on prevention of bypass graft occlusion' 9 "" 1416 ', even in the study of Chesebro' 13 ', where the importance of preoperative start of medication was emphasized.…”