Stopping Aspirin Before Coronary Artery Surgery

Myles, Paul S.

doi:10.1161/circulationaha.110.010470

Cited by 17 publications

(4 citation statements)

References 32 publications

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“…However, given new platelet production, overall functional inhibition persists for approximately 5 days. 2 In addition, many procedures can be undertaken with noncoagulopathic patients on low-dose aspirin with minimal or no increased risk of bleeding, including cardiopulmonary bypass (CPB) 3 and dental extraction. 4 Other NSAIDs inhibit platelets while the drug is in the circulation.…”

Section: Bleeding Complications Of Drugs Used For Therapeutic Platelementioning

confidence: 99%

Acquired Disorders of Platelet Function

Konkle

2011

Hematology

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Platelet dysfunction is commonly acquired due to medications, procedures, medical conditions, and underlying hematologic disease. These issues are presented, the data reviewed, and recommendations given herein. Many medications and dietary supplements have platelet-inhibitory effects in vitro, although the clinical effects on bleeding risks are unclear for many. Platelet-inhibitory drugs are key in the treatment of vascular disease. Data are available to aid in the management of these medications to prevent hemorrhagic complications. Bleeding in patients with renal failure has decreased with improved dialysis and the use of erythropoietin, but remains a challenge. Platelet dysfunction accompanies cardiac valvular disease and use of cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation. Hematologic disorders including myeloproliferative disorders (MPDs), myelodysplasia, paraproteinemias, and immune thrombocytopenia (ITP) can also be associated with hemorrhagic complications due to platelet dysfunction. Knowledge of which factors affect bleeding risk and how to treat individuals with acquired platelet dysfunction are important in optimizing patient care.

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Section: Bleeding Complications Of Drugs Used For Therapeutic Platelementioning

confidence: 99%

Acquired Disorders of Platelet Function

Konkle

2011

Hematology

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“…Aspirin as a choice for the prevention of graft occlusion and adverse cardiac events after coronary artery bypass graft surgery [ 27 ], we want to explore its use on platelet inhibition. Perioperative myocardial infarction is the main cause of morbidity and death after coronary artery bypass grafting, and platelet inhibition has been shown to reduce the incidence of acute bypass occlusion after coronary artery bypass graft surgery [ 28 , 29 ]. In the study, there was no significant statistical difference in the platelet aggregation rate of the two groups upon admission, but the postoperative test found that the platelet aggregation rate of the two groups showed a certain degree of increase, which may be related to surgery.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Off‐Pump Coronary Artery Bypass Grafting in Patients on Aspirin Therapy until Surgery Day

Liu

Yang

et al. 2022

Contrast Media & Molecular Imaging

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Coronary artery bypass grafting (CABG) is widely used to treat coronary artery disease, and intraoperative and postoperative bleeding is one of the major factors affecting the efficacy and mortality of CABG. To overcome the adverse effects of extracorporeal circulation (CPB), nonextracorporeal coronary artery bypass grafting (OPCABG) has become the main modality of CABG but is still prone to thromboembolic events. Whether antiplatelet agents should be clinically applied before CABG, especially OPCABG, remains controversial. Aspirin is currently the most important perioperative oral antiplatelet agent for coronary artery bypass graft surgery. In this study, we evaluated the effect of continuing aspirin therapy before OPCABG and observed perioperative performance and physiological indicators to find evidence for continuing aspirin therapy before surgery in China. The study showed that preoperative aspirin application had a positive effect on enhancing early postoperative platelet inhibition without increasing the incidence of adverse effects such as cardiovascular events. This provides an important clinical reference for whether antiplatelet agents should be applied before CABG, especially OPCABG.

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“…Conversely, there has been controversy on the preoperative administration of aspirin for CABG patients, as aspirin increases the risk of bleeding 26). Recent studies showed contradictory results regarding preoperative aspirin use.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Preoperative Aspirin on Coronary Artery Bypass Surgery: a Systematic Meta-Analysis

et al. 2019

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Background and Objectives Aspirin plays an important role in the maintenance of graft patency and the prevention of thrombotic event after coronary artery bypass graft surgery (CABG). However, the use of preoperative aspirin is still under debate due to the risk of bleeding. Methods From PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, data were extracted by 2 independent reviewers. Meta-analysis using random effect model was performed. Results We performed a systemic meta-analysis of 17 studies (12 randomized controlled studies and 5 non-randomized registries) which compared clinical outcomes of 9,101 patients who underwent CABG with or without preoperative aspirin administration. Preoperative aspirin increased chest tube drainage (weighted mean difference 177.4 mL, 95% confidence interval [CI], 41.3–313.4; p=0.011). However, the risk of re-operation for bleeding was not different between the preoperative aspirin group and the control group (3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94–1.60; p=0.102). There was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR, 0.98; 95% CI, 0.64–1.49; p=0.920) and myocardial infarction (MI) (8.7% vs. 10.4%; OR, 0.83; 95% CI, 0.66–1.04; p=0.102) between patients with and without preoperative aspirin administration. Conclusions Although aspirin increased the amount of chest tube drainage, it was not associated with increased risk of re-operation for bleeding. In addition, the risks of early postoperative all-cause mortality and MI were not reduced by using preoperative aspirin.

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Stopping Aspirin Before Coronary Artery Surgery

Cited by 17 publications

References 32 publications

Acquired Disorders of Platelet Function

Acquired Disorders of Platelet Function

The Effect of Off‐Pump Coronary Artery Bypass Grafting in Patients on Aspirin Therapy until Surgery Day

The Effects of Preoperative Aspirin on Coronary Artery Bypass Surgery: a Systematic Meta-Analysis

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