Effect of Timing of Chronic Preoperative Aspirin Discontinuation on Morbidity and Mortality in Coronary Artery Bypass Surgery

Abstract

Background— Aspirin (ASA) has been shown to reduce postoperative coronary artery bypass grafting (CABG) mortality and ischemic events; however, the timing of chronic ASA discontinuation before surgery is controversial because of concern about postoperative bleeding. We evaluated the effect of the timing of ASA discontinuation before CABG on major adverse cardiovascular outcomes and postoperative bleeding using the Cleveland Clinic Cardiovascular Information Registry database. Methods and Results— At the Cleveland Clinic between January 1, 2002, and January 31, 2008, 4143 patients undergoing CABG were taking preoperative chronic ASA. Of these, 2298 discontinued ASA 6 or more days before surgery (early discontinuation), and 1845 took ASA within 5 days of the surgery (late use). Because of substantial differences between these 2 groups, propensity score analysis, and matching based on 31 variables were used for fair comparison of outcomes. This resulted in 1519 well-matched pairs of patients (73%). There was no significant difference between those with early discontinuation and late ASA use with regard to the composite outcome of in-hospital mortality, myocardial infarction, and stroke (1.7% versus 1.8%, P =0.80). Late use was associated with more intraoperative transfusions (23% versus 20%, P =0.03) and postoperative transfusions (30% versus 26%, P =0.009) but a similar number of reoperations for bleeding (3.4% versus 2.4% P =0.10). Conclusions— Among patients undergoing isolated CABG, late discontinuation of ASA resulted in no difference in postoperative cardiovascular outcomes; however, there was an increased transfusion requirement. Thus, we recommend weighing the risks and benefits of late ASA use in these patients.

Stopping Aspirin Before Coronary Artery Surgery

“…2 Professional organizations differ in their recommendations, 18 -20 with some recommending stopping 3 to 5 days before surgery and others recommending 7 to 10 days. The present report by Jacob and colleagues 21 indicate that late (within 5 days of CABG) discontinuation of aspirin is not associated with any measurable differences in thrombotic complications after CABG when compared with early (at least 6 days before CABG) discontinuation. Rates of a composite outcome that included in-hospital myocardial infarction, stroke, and mortality were comparable between groups: 1.7% versus 1.8%; Pϭ0.8.…”

Preoperative Aspirin Use and Its Effect on Adverse Events in Patients Undergoing Cardiac Operations

“…[8,9,24]. In contrast, there is research supporting discontinuation of aspirin before cardiac operations [10]. In our study, we found that in patients undergoing CABG only, preoperative aspirin use was not associated with risks of MACE, postoperative renal failure, 30-day mortality, reoperation for bleeding, blood transfusion, or postoperative infection.…”

“…In the postoperative period, early aspirin therapy has been consistently reported to improve clinical outcomes for patients undergoing coronary artery bypass grafting (CABG), including better graft patency [3][4][5][6] and a reduced risk of death and ischemic complications [7]. However, whether aspirin should be used in the preoperative period remains controversial [8][9][10][11][12][13]. Several studies showed lower mortality [8,9] in patients undergoing CABG, whereas others found a similar mortality rate and higher transfusion requirement [10,[14][15][16][17].…”

“…However, whether aspirin should be used in the preoperative period remains controversial [8][9][10][11][12][13]. Several studies showed lower mortality [8,9] in patients undergoing CABG, whereas others found a similar mortality rate and higher transfusion requirement [10,[14][15][16][17]. Decisions about preoperative aspirin therapy in patients undergoing CABG are made widely on the basis of individual and institutional experiences [11][12][13].…”

Circulation 's Editors' Picks

“…Thus, we recommend weighing the risks and benefits of late aspirin use in these patients. 6 onset from 2003 to 2009 in 1082 hospitals participating in the Get With the Guidelines-Stroke Program were analyzed to determine frequency, patient and hospital characteristics, and temporal trends in patients treated with door-to-needle times Յ60 minutes. Only 26.6% of tPA-treated patients had a door-to-needle time Յ60 minutes.…”