Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study

Mazzeffi, Michael; Galvagno, Samuel M.; Gammie, James S.; Tanaka, Kenichi A.

doi:10.1007/s00540-016-2213-2

Cited by 4 publications

(7 citation statements)

References 31 publications

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“…The minimum number of RBCs in MRT has been variously set at 4, [3] 5, [17] 6, [9] or 8, [28] and we opted for 4 as our cut-off because morbidity sharply increases beyond this level, [8] and postoperative complications even increase 19.4% ( P < .01) when the patients receive ≥4 units of RBCs. [29]…”

Section: Discussionmentioning

confidence: 99%

Risk of massive blood product requirement in cardiac surgery

et al. 2019

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Cardiac surgery under cardiopulmonary bypass (CPB) accounts for most consumption of red blood cells (RBCs). Identifying risk factors for massive red blood cell transfusion (MRT) in cardiac surgery may help to reduce this consumption. We retrospectively analyzed 8238 patients who underwent valve surgery and/or coronary artery bypass grafting (CABG) under CPB at 2 major heart centers in China. Uni- and multivariate logistic regression was carried out to assess whether risk factors for MRT (defined as receiving at least 4 units RBCs) varied with type of cardiac surgery. A total of 1691 patients (21%) received at least 4 units RBCs (6.77 ± 4.78 units per person). This MRT group consumed 70% of the total units of allogeneic RBCs in the study. MRT incidence was 2-fold higher among patients undergoing CABG with or without valve surgery than among patients undergoing valve surgery alone. Multivariate logistic analysis identified the following MRT risk factors common to valve surgery alone, CABG alone, and their combination: female sex, older age, renal dysfunction, lower body mass index, lower preoperative hemoglobin, and longer CPB. Several independent MRT risk factors were also identified specific to valve surgery: active endocarditis, nonatrial fibrillation, smaller left atrium diameter, abnormal international normalized ratio, and repeat surgery. Different types of cardiac surgery share several, but not all, MRT risk factors. This study may help guide the prediction and management of patients at higher MRT risk.

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Section: Discussionmentioning

confidence: 99%

Risk of massive blood product requirement in cardiac surgery

et al. 2019

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“…Search results: From 858 initial citations, six eligible studies, which included a total of 11,406 patients, were identified in the present meta-analysis [Hur 2017;Mazzeffi 2016;Huang 2015;Yao 2015;Myles 2016], with 6,280 patients in the aspirin group and 5,126 in the control group. Characteristics of the included studies and patients are summarized in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Besides the above concerns, some studies also found protective effect of preoperative aspirin on CSA-AKI [Hur 2017;Huang 2015;Yao 2015;. Other studies found no positive effect of preoperative aspirin [Mazzeffi 2016;Myles 2016].…”

Section: Introductionmentioning

confidence: 98%

“…Anti-inflammatory strategies to moderate inflammatory response, including glucocorticoid, miniaturized extracorporeal circuit, and the leukocyte filter, have been investigated [Shin 2016]. Recent observational studies also indicate that preoperative aspirin may have a protective effect on CSA-AKI [Hur 2017;Mazzeffi 2016;Huang 2015;Yao 2015;.…”

Section: Introductionmentioning

confidence: 99%

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

Liu

Chen

et al. 2019

HSF

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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). Objective: To estimate the efficacy of preoperative aspirin in preventing CSA-AKI. 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 < 0.01] and 30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P < 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). 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.

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“…Further, perioperative aspirin use may be beneficial in cardiac surgery, decreasing complications such as MI and renal failure after surgery [121315]. Aspirin may even confer a lung protective effect after massive transfusion after cardiac surgery as reported in one observational study [16]. …”

Section: Platelet Inhibitors and Cardiac Surgerymentioning

confidence: 99%

Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y₁₂inhibitors

Mazzeffi

Lee

Taylor

et al. 2017

Korean J Anesthesiol

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Platelets play pivotal roles in hemostasis as well as pathological arterial thrombosis. The combination of aspirin and a P2Y12 inhibitor has become the mainstay therapy in the ageing population with cardiovascular conditions, particularly during and after percutaneous coronary intervention. A number of novel P2Y12 inhibitors has become available in the recent years, and they markedly vary in pharmacokinetic and pharmacodynamic properties. Perioperative physicians today face a challenge of preventing hemorrhage due to platelet inhibitors, while minimizing thrombotic risks. There are several point-of-care platelet function tests available in the peri-procedural assessment of residual platelet aggregation. However, these platelet function tests are not standardized in terms of sample processing, agonist type and potency as well as methods of detecting platelet activity. Understanding the differences in pharmacological properties of antiplatelet agents, principles of platelet function tests, and pertinent hemostatic strategies may be useful to anesthesiologists and intensivists who manage perioperative issues associated with antiplatelet agents. The objectives of this review are: 1) to discuss clinical data on aspirin and P2Y12 inhibitors relating to perioperative bleeding, 2) to outline different features of point-of-care platelet function tests, and 3) to discuss therapeutic options for the prevention and treatment of bleeding associated with antiplatelet agents.

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Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study

Abstract: Preoperative aspirin use is not associated with decreased in-hospital mortality in massively transfused cardiac surgery patients, but may be associated with less mechanical lung ventilation time.

Cited by 4 publications

References 31 publications

Risk of massive blood product requirement in cardiac surgery

Risk of massive blood product requirement in cardiac surgery

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

Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y₁₂inhibitors

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Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study

Abstract: Preoperative aspirin use is not associated with decreased in-hospital mortality in massively transfused cardiac surgery patients, but may be associated with less mechanical lung ventilation time.

Cited by 4 publications

References 31 publications

Risk of massive blood product requirement in cardiac surgery

Risk of massive blood product requirement in cardiac surgery

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

Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y12inhibitors

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Perioperative management and monitoring of antiplatelet agents: a focused review on aspirin and P2Y₁₂inhibitors