Does pre-operative aspirin 300 mg daily increase post-operative blood loss and decrease platelet aggregation in patients with chronic stable angina undergoing elective coronary artery surgery?
Continuing aspirin 300 mg daily up to the day of elective coronary artery surgery successfully inhibits platelet aggregation but significantly increases the risk of post-operative bleeding and the need for transfusions or re-exploration.
Aspirin has an established benefit in reducing the incidence of coronary events and vein graft occlusion. We have now assessed the risk of pre-operative aspirin in a prospective, randomised, double-blind clinical trial in 100 patients scheduled for elective coronary artery surgery. Any prescribed aspirin and non-steroidal anti-inflammatory drugs were discontinued 2 weeks pre-operatively and these were replaced by a randomly assigned tablet of either aspirin 300 mg daily or placebo taken until the day of surgery. Patient compliance was confirmed by serum and urinary salicylate analysis. The two groups were similar in demographic characteristics, bypass time, number of grafts placed and number of internal mammary arteries used. All patients survived to be discharged home (see Table). Aspirin decreases platelet aggregation to arachidonic acid and to collagen both pre- and post-operatively. The benefit of pre-operative aspirin has to be balanced against the risk of increasing post-operative blood loss, re-exploration for excessive bleeding and transfusion requirements.
Kallis et al. (1994) studied this question.