Key result
Continuing aspirin until surgery cuts preoperative angina ~48% without increasing major adverse events.
Why the study?
Whether antiplatelet agents such as aspirin should be continued before CABG, especially OPCABG, remains controversial due to competing risks of bleeding and thromboembolic events.
Does continuing aspirin therapy until the day of surgery reduce preoperative cardiovascular events and improve platelet inhibition in patients undergoing off-pump coronary artery bypass grafting?
RCT (n=300)
Double-blind
Table of random numbers
No
Does continuing aspirin therapy until the day of surgery reduce preoperative cardiovascular events and improve platelet inhibition in patients undergoing off-pump coronary artery bypass grafting?
Absolute Event Rate: 11% vs 21%
p-value: p=0.015
Continuing aspirin until the day of OPCABG is safe and effective for platelet inhibition, supporting guideline recommendations in a Chinese population despite increased surgical bleeding.
Supports aspirin continuation until OPCABG; confirms safety and reinforces guidelines in this population.
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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Liu et al. (2022) conducted an RCT in Severe three-vessel coronary artery disease or left main coronary artery disease (n=300). Aspirin vs. Aspirin discontinuation for 5-7 days before surgery was evaluated on Preoperative angina (p=0.015). Continuing aspirin therapy until the day of surgery reduced preoperative angina (11% vs 21%, p=0.015) and enhanced postoperative platelet inhibition without increasing major adverse events.
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