Key result
Continuing aspirin before off-pump CABG is linked to increased bleeding versus stopping 5-7 days prior.
Why the study?
Guidelines recommend continuing aspirin before CABG, but the effect of continuing aspirin in patients with a prior indication, especially during off-pump CABG, had not been systematically evaluated.
Does continuation of aspirin until the day of surgery increase bleeding and blood product usage in patients undergoing off-pump or on-pump CABG?
Cohort
Does continuation of aspirin until the day of surgery increase bleeding and blood product usage in patients undergoing off-pump or on-pump CABG?
Continuing aspirin prior to CABG and OPCABG is safe regarding mortality and thromboembolism, though it may increase bleeding and blood product usage specifically during OPCABG.
Answers are grounded in this paper and cite their sources.
May increase bleeding and transfusions in OPCABG without mortality or thromboembolic impact; leaves open optimal aspirin strategy pending randomized trials.
Major bleeding is linked to poorer outcomes following cardiac surgery. Current guidelines recommend continuation of aspirin prior to coronary artery by-pass graft (CABG) but the effect of continuing aspirin in patients with prior indication for aspirin, in particular during off-pump CABG (OPCABG), has not been systematically assessed. In this study, we analysed the effect of continuing aspirin prior to OPCABG and on-pump CABG with respect to bleeding and blood product usage. We compared propensity-matched cohorts of patients who continued aspirin until the day of OPCABG or CABG to controls (no antiplatelet) and to patients discontinuing aspirin 5-7 days prior. Length of hospital stay, 30-day mortality and thromboembolism rates were similar for both OPCABG and CABG. During OPCABG, aspirin-continued patients received more intraoperative red cell units compared to controls without difference in bleeding. Aspirin-continued patients received more blood products perioperatively and bled more than aspirin-discontinued patients undergoing OPCABG. The only difference during CABG was a small increase in the volume of cells salvaged among aspirin-continued patients compared to controls. Current guidelines on the continuation of aspirin prior to CABG and OPCABG are safe. Continuation of aspirin prior to OPCABG may result in more bleeding and blood product usage.
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Little et al. (2022) conducted a cohort in Coronary artery bypass graft surgery. Continuation of aspirin until the day of surgery vs. No antiplatelet or discontinuation of aspirin 5-7 days prior was evaluated on Bleeding and blood product usage. Continuing aspirin prior to off-pump CABG resulted in more bleeding and blood product usage compared to discontinuing it 5-7 days prior, though mortality and thromboembolism rates were similar.
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