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Timing of aspirin discontinuation before CABG failed to affect morbidity, mortality rates
Jacob M. Circulation. 2011;123:577-583.
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Patients undergoing CABG who discontinued aspirin therapy more than 6 days before surgery had similar morbidity and mortality rates to patients who stopped taking aspirin 5 or fewer days before surgery, study results suggested.
“Aspirin has been shown to reduce postoperative [CABG] mortality and ischemic events,” the researchers said. “However, there has been controversy regarding the timing of [aspirin] discontinuation before CABG surgery owing to concern about postoperative bleeding complications.”
Currently, the guidelines for aspirin use before CABG surgery are varied. The American College of Cardiology/American Heart Association recommends discontinuing aspiring 7 to 10 days before surgery, whereas The Society of Thoracic Surgeons recommends discontinuation at 3 to 5 days, according to the study.
The researchers tracked 4,143 patients who underwent CABG at the Cleveland Clinic from 2002 to 2008. All patients were taking preoperative aspirin when scheduled for surgery. A total of 2,298 patients in the early discontinuation group stopped taking aspirin 6 or more days before surgery, and 1,845 patients in the late use group took aspirin within 5 days of surgery.
Because of substantial differences between the two groups, the researchers sought to create a fair comparison by using a propensity score analysis with 31 matching variables. These included patient factors associated with late aspirin use, renal health, coronary stenosis and preoperative medications taken. Overall, the researchers narrowed the patient population to 1,519 well-matched pairs.
The two groups of patients did not experience any significant differences with regard to the composite outcome of in-hospital mortality, MI and stroke (1.7% vs. 1.8%, P=.80), according to the study. Late aspirin use was linked to a higher rate of intraoperative blood transfusions (23% vs. 20%, P=.03) and a higher rate of postoperative blood transfusions (30% vs. 26%, P=.009). Overall, the both groups had a similar rate of reoperations due to bleeding (3.4% vs. 2.4%, P=.10).
“On the basis of the present study, we recommend that clinicians weigh the risks and benefits of late [aspirin] use on the basis of the patient's risk profile before CABG,” the researchers concluded.
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