Key result
Preoperative aspirin before CABG does not increase bleeding risk or reduce early mortality and MI.
Why the study?
The use of preoperative aspirin remains under debate due to concerns regarding bleeding risk, despite its role in maintaining graft patency and preventing thrombotic events after CABG.
Does preoperative aspirin administration increase bleeding or improve clinical outcomes in patients undergoing coronary artery bypass graft surgery?
Meta-Analysis (n=9,101)
Does preoperative aspirin administration increase bleeding or improve clinical outcomes in patients undergoing coronary artery bypass graft surgery?
Effect estimate: OR 1.23 (95% CI 0.94-1.60)
Absolute Event Rate: 3.2% vs 2.4%
p-value: p=0.102
Preoperative aspirin before CABG increases postoperative chest tube drainage but does not significantly increase the risk of re-operation for bleeding, nor does it reduce early mortality or myocardial infarction.
Preoperative aspirin in CABG raises drainage without increasing reoperation bleeding and shows no mortality/MI benefit; confirms neutral risk-benefit profile for individualized decisions.
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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Hwang et al. (2019) conducted a meta-analysis in Coronary Artery Bypass Graft Surgery (CABG) (n=9,101). Preoperative aspirin vs. No preoperative aspirin (placebo or discontinued ≥4-5 days before CABG) was evaluated on Re-operation for bleeding (OR 1.23, 95% CI 0.94-1.60, p=0.102). Preoperative aspirin before CABG did not significantly increase the risk of re-operation for bleeding compared to no aspirin (OR 1.23), nor did it reduce early all-cause mortality or MI.
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