Effect of aspirin in coronary artery bypass grafting

Vuylsteke, Alain; Oduro, A.; Cardan, E; Latimer, R.D.

doi:10.1016/s1053-0770(97)90115-4

Cited by 54 publications

(38 citation statements)

References 16 publications

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“…This fact is attributed to the prior use of aspirin and protein IIb/IIIa inhibitors, which was not confirmed in this study. Aspirin as a risk factor for bleeding is controversial [21,22]. Although we did not evidence more bleeding in patients who had ingested aspirin, the operation was usually postponed for one week, depending on the preoperative clinical conditions.…”

Section: Commentscontrasting

confidence: 55%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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Objective: To determine predictors of postoperative bleeding after cardiac surgery, in order to focus on preventive measures for high-risk populations.Methods: From October 2001 to March 2002, 411 consecutive adult cardiac surgery patients were prospectively studied, with the exception of those submitted to heart transplantation. In order to determine risk factors for postoperative bleeding, 20 preoperative, 17 operative and 6 postoperative variables were analyzed using univariate methods and multiple linear regression.Results: Operative procedures included coronary artery bypass grafting in 227 (55.2%) patients, valvar operations in 198 (48.2%), aortic surgery in 25 (6.1%) and combined procedures in 60 (14.6%). Cardiopulmonary bypass was used in 335 (81.5%) patients and anti-fibrinolysis agents in 148 (36%). The thirty-day mortality rate was 5.6% (23 patients). Mean 24-hour postoperative blood loss was 610 ± 500 mL (range 10-4900). Re-exploration for bleeding was required in 15 (3.7%) patients. Independent predictors of postoperative bleeding were emergency operations (p=0.049), postoperative metabolic acidosis (p=0.001), preoperative thrombocytopenia (p=0.034) and prolonged cardiopulmonary bypass (p=0.021).Conclusions: When possible, preoperative stabilization and correction of coagulation disturbances should be achieved in patients requiring urgent or emergent surgery and in those with thrombocytopenia. The duration of cardiopulmonary bypass should be minimized as long as this is practical. Postoperative metabolic acidosis must be actively corrected, especially the main determining causes. Descriptors

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Section: Commentscontrasting

confidence: 55%

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Miana¹,

Atik²,

Moreira³

et al. 2004

Rev Bras Cir Cardiovasc

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“…9 -12 A number of other studies indicate that aspirin ingestion is not associated with postoperative bleeding. [13][14][15][16][17][18][19][20][21][22][23][24][25][26] This may be due to other confounding factors that contribute to the problem of postoperative bleeding that are independent of platelet-related abnormalities. Some examples include problems with surgical hemostasis, the direct and indirect effects of cardiopulmonary bypass, and drug-induced coagulopathies, especially those related to heparin/protamine administration.…”

Section: Discussionmentioning

confidence: 99%

Aspirin and Postoperative Bleeding After Coronary Artery Bypass Grafting

Ferraris

Ferraris²,

Joseph³

et al. 2002

Annals of Surgery

102

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ObjectiveTo evaluate the relationship between aspirin ingestion and postoperative bleeding complications, and to test the hypothesis that there is a subset of patients who are aspirin hyperresponders with a proclivity toward platelet dysfunction. Summary Background DataDespite numerous retrospective and prospective analyses, it is still controversial as to whether aspirin ingestion before coronary artery bypass grafting (CABG) is associated with significant postoperative bleeding. MethodsBetween January 1995 and December 1999, the records of 2,606 consecutive patients undergoing CABG were reviewed to identify patients with a history of aspirin ingestion up until the time of surgery. Aspirin ingestion was correlated with postoperative blood transfusion using multivariate analysis. In a subset of preoperative aspirin users (n ϭ 40), bleeding times were measured before and after aspirin use. Flow cytometry was performed in another cohort of patients with known heart disease (n ϭ 30) to determine the effect of aspirin on platelet surface receptors. ResultsDuring the 5-year study period, 63% of the CABG patients were identified as aspirin users. Among these, 23.1% required blood transfusions compared with 19% for the nonusers. Non-red blood cell transfusions were more common in aspirin users, as was reexploration for bleeding. Stratification of these results according to the frequency of aspirin use showed that aspirin is an independent multivariate predictor of postoperative blood transfusion only in high-risk patients. In the prospective studies, aspirin treatment resulted in a significant increase in the template bleeding time, an increase in platelet PAR-1 thrombin receptor activity, and a decrease in the binding of platelets to monocytes. ConclusionsThe findings support the hypothesis that aspirin is associated with a greater likelihood of postoperative bleeding. A platelet function testing algorithm that combines preoperative risk factor assessment, template bleeding times, and flow cytometry may allow the identification of aspirin hyperresponders who are at increased risk for bleeding.

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“…A similar low risk of bleeding in patients with low-dose aspirin medication was observed by Shiffmann et al [46] after endoscopic biopsy or polypectomy, and by Madan et al [30] who conducted a prospective study and performed minor oral surgery in 51 patients without stopping daily low-dose aspirin therapy. When focusing on more invasive operative procedures, like in the topic of prostatectomy [35,50,54] and cardiac surgery [3,8,9,14,20,33,44,45,53], aspirin is a recognized risk factor contributing to excessive peri-operative bleeding and the need for reoperation. Watson et al [54] identified aspirin ingestion, already in 1990, to be a significant etiological factor in post-prostatectomy hemorrhage, and Nielsen et al [35] approved the same statement in a prospective, randomized, double-blind, placebo-controlled study 10 years later.…”

Section: Comparable Surveysmentioning

confidence: 99%

Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany

2006

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The main problem faced by the increasing numbers of patients presenting for spinal surgery are receiving concurrent medication with low-dose aspirin, leading to dysfunctional circulating platelets. The contribution of low-dose aspirin to increased peri-operative risk of bleeding and blood loss is a contentious issue with conflicting published results from different surgical groups. Data from neurosurgical spine patients is sparse, but aspirin has been identified as an important risk factor in the development of post-operative hematoma following intracranial surgery. We surveyed the opinions and working practices of the neurosurgical facilities performing spinal operations in Germany regarding patients who present for elective spinal surgery. Identical questionnaires were sent to 210 neurosurgical facilities and proffered five main questions: (1) the adherence of any policy of stopping aspirin pre-operatively, (2) the personal risk assessment for patients with spinal surgery under low-dose aspirin medication, (3) the preferred method of treatment for excessive bleeding in this context, (4) personal knowledge of hemorrhagic complications in this group of patients, and (5) the characteristics of the neurosurgical units concerned. There were 145 (69.1%) responses of which 142 (67.6%) were valid. Of the respondents, 114 (80.3%) had a (written) departmental policy for the discontinuation of pre-operative aspirin treatment, 28 (19.7%) were unaware of such a policy. The mean time suggested for discontinuation of aspirin pre-operatively was 6.9 days (range: 0-21 days), with seven respondents who perform the operations despite the ongoing aspirin medication. Ninety-four respondents (66.2%) considered that patients taking low-dose aspirin were at increased risk for excessive peri-operative hemorrhage or were indetermined (8.6%), and 73 (51.4%) reported having personal experience of such problems. Ninety-two respondents (65.5%) would use special medical therapy, preferably Desmopressin alone or in combination with other blood products or prohemostatic agents (46.1%), if hemorrhagic complications developed intra- or post-operatively. The average number of spinal operations per year in each service was 607.9 (range: 40-1,500). Despite the existence of distinct departmental policies concerning the discontinuation of low-dose aspirin pre-operatively in the majority of neurosurgical facilities performing spinal operations, there is a wide range of the moment of this interruption with an average of 7 days. Two-thirds of the respondents felt that aspirin was a risk factor for hemorrhagic complications associated with spinal procedures, and more than half of the interviewees reported having personal experience of such problems. Finally, various medicamentous methods of counteracting aspirin-induced platelet dysfunction and excessive bleeding in this context are elicited, discussed and evaluated.

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Effect of aspirin in coronary artery bypass grafting

Cited by 54 publications

References 16 publications

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Fatores de risco de sangramento no pós-operatório de cirurgia cardíaca em pacientes adultos

Aspirin and Postoperative Bleeding After Coronary Artery Bypass Grafting

Low-dose aspirin before spinal surgery: results of a survey among neurosurgeons in Germany

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