Preoperative Aspirin Use and Outcomes in Cardiac Surgery Patients

Abstract

Preoperative aspirin therapy is associated with a significant decrease in the risk of major cardiocerebral complications, renal failure, intensive care unit stay and 30-day mortality but does not increase the risk of readmissions in patients undergoing cardiac surgery.

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

“…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].…”

“…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]. Actually, the American Heart Association, American College of Cardiology [18], The Society of Thoracic Surgeons (STS) [19], and the European Association for Cardio-Thoracic Surgery [20] even make different recommendations about when preoperative aspirin therapy should be terminated, ranging between 2 and 10 days before elective cardiac operations.…”

“…Cao and associates [11,12] assessed a cohort consisting of all cardiac procedures and found that aspirin was associated with a lower cumulative incidence of major adverse cardiocerebral events (MACE), renal failure, intensive care unit stay, and 30-day mortality [11,12].…”

Perioperative Stroke

“…If a procedure is associated with significant bleeding, discontinuation of antiplatelet therapy should be considered and treatment restarted as soon as the risk of surgical bleeding is considered to be low, with appropriate bridging strategies. Several studies have confirmed that aspirin taken within 5 days prior to cardiac surgery is protective against perioperative stroke [60][61][62]. The evidence for this protection is less conclusive for noncardiac, noncarotid surgery, except for hip arthroplasty [63].…”

Continuing aspirin before coronary artery bypass grafting surgery: old fears challenged by new evidences

“…Aspirin continuation was shown to reduce postoperative myocardial infarction, improve myocardial oxygenation and increase survival (11), and platelet inhibition was found to prevent acute bypass graft occlusion early after CABG (12). Further studies proved that aspirin treatment was associated with reduced operative morbidity and cardiac complications (6,7,12,13), with no increase in blood product use (14). Most importantly, aspirin use was proven to be safe before CABG compared to placebo, with no increased risk of bleeding or hemorrhagic complication.…”