Aspirin Does Not Increase Bleeding and Allogeneic Blood Transfusion in Coronary Artery Surgery

Abstract

Background: Traditionally, the administration of aspirin is stopped seven days before coronary artery bypass surgery to reduce the risk of postoperative bleeding. The aim of this study was to evaluate the effect of preoperative aspirin on bleeding in these patients. Methods: A prospective nonrandomized unblinded study was carried out at the King Abdullah University Hospital in Jordan/Irbid from June 2005 to December 2009 in 756 patients. Patients were divided into 2 groups: Group 1 (n = 400) consisted of patients on aspirin, 100 mg/day, until the day of surgery; Group 2 (n = 356) consisted of patients who stopped taking aspirin seven days before surgery. The groups were compared to evaluate the effect of preoperative aspirin on bleeding in patients undergoing elective coronary artery bypass surgery. Data were collected and compared and included total amount of postoperative chest tube drainage, number of transfused units of blood and blood products, and numbers of patients who required reexploration for bleeding. Results were considered significant when p < 0.05. Results: There was no significant increase in the amount of blood loss, units of transfused blood products, or the incidence of reexploration between the two groups (p > 0.05). Conclusion: Aspirin does not increase bleeding or increase the need for allogeneic blood transfusion in coronary artery surgery.

Key words

coronary bypass surgery - cardiovascular surgery - heart disease

References

• 1 Sethi G K, Copeland J G, Goldman S, Moritz T, Zadina K, Henderson W G. Should aspirin be discontinued before coronary artery bypass surgery?.  Circulation. 2005;  112 e85-e90
• 2 Eagle K A, Guyton R A, Davidoff R. et al. for the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery . ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.  J Am Coll Cardiol. 2004;  44 e213-310
• 3 Stein P D, Schunemann H J, Dalen J E, Gutterman D. Antithrombotic therapy in patients with saphenous vein and internal mammary artery bypass grafts: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.  Chest. 2004;  126 (Suppl. 3) 600S-608S
• 4 Antiplatelet Trialists' Collaboration . Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.  BMJ. 2002;  324 71-86
• 5 Hayat J, Dihmis W C. Preoperative and immediate postoperative aspirin also reduces morbidity.  Ann Thorac Surg. 2001;  72 1797-1798
• 6 Goldman S, Copeland J, Moritz T and the Department of Veterans Affairs Cooperative Study Group et al. Starting aspirin therapy after operation: effects on early graft patency.  Circulation. 1991;  84 520-526
• 7 Goldman S, Copeland J, Moritz T et al. Improvement in saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration Cooperative Study.  Circulation. 1988;  77 1324-1332
• 8 Hockings B E F, Ireland M A, Gotch-Martin K F, Taylor R R. Placebo-controlled trial of enteric coated aspirin in coronary bypass graft patients.  Med J Aust. 1993;  159 376-378
• 9 Vuylsteke A, Oduro A, Cardan E, Latimer R D. Effect of aspirin in coronary artery bypass grafting.  J Cardiothorac Vasc Anesth. 1997;  11 831-834
• 10 Dacey L J, Munoz J J, Johnson E R Northern New England Cardiovascular Disease Study Group et al. Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients.  Ann Thorac Surg. 2000;  70 (6) 1986-1990
• 11 Bybee K A, Powell B D, Valeti U et al. Preoperative aspirin therapy is associated with improved postoperative outcomes in patients undergoing coronary artery bypass grafting.  Circulation. 2005;  112 (Suppl. 1) I-286-I-292
• 12 Ferraris V A, Ferraris S P, Lough F C, Berry W R. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting.  Ann Thorac Surg. 1988;  45 71-74
• 13 Sethi G K, Copeland J G, Goldman S, Moritz T, Zadina K, Henderson W G. and the Department of Veterans Affairs Cooperative Study Group . Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting.  J Am Coll Cardiol. 1990;  15 15-20
• 14 Kallis P, Tooze J A, Talbot S, Cowans D, Bevan D H, Treasure T. Pre-operative aspirin decreases platelet aggregation and increases post-operative blood loss: a prospective, randomized, placebo controlled, double-blind clinical trial in 100 patients with chronic stable angina.  Eur J Cardiothorac Surg. 1994;  8 404-409
• 15 Taggart D P, Siddiqui A, Wheatley D J. Low-dose preoperative aspirin therapy, postoperative blood loss, and transfusion requirements.  Ann Thorac Surg. 1990;  50 425-428
• 16 Tuman K J, McCarthy R J, O'Connor C J, McCarthy W E, Ivankovich A D. Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery.  Anesth Analg. 1996;  83 (6) 1178-1184
• 17 Bashein G, Nessly M L, Rice A L et al. Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery.  Arch Intern Med. 1991;  151 89-93
• 18 Boldt J, Knothe C, Zickmann B et al. The effects of preoperative aspirin therapy on platelet function in cardiac surgery.  Eur J Cardiothorac Surg. 1992;  6 598-602
• 19 Torosian M, Michelson E L, Morganroth J, MacVaugh H. Aspirin- and coumadin-related bleeding after coronary-artery bypass graft surgery.  Ann Intern Med. 1978;  89 525-528
• 20 Troianos C A, Mathie T B, Galaska H J et al. Perioperative factors associated with homologous blood transfusions and cardiac surgery [abstract].  Anesth Analg. 1996;  82 SCA104
• 21 Despotis G J, Filos K S, Zoys T N, Spitznagel E, Lappas D G. Factors associated with excessive postoperative blood loss and hemostatic transfusion requirements: a multivariate analysis in cardiac surgical patients.  Anesth Analg. 1996;  82 13-21
• 22 Paone G, Spencer T, Silverman N A. Blood conservation in coronary artery surgery.  Surgery. 1994;  116 672-678
• 23 Reich D L, Patel G C, Vela-Cantos F, Bodian C, Lansman S. Aspirin does not increase homologous blood requirements in elective coronary bypass surgery.  Anesth Analg. 1994;  79 4-8
• 24 Rawitscher R E, Jones J W, McCoy T A, Lindsley D A. A prospective study of aspirin's effect on red blood cell loss in cardiac surgery.  J Cardiovasc Surg. 1991;  32 1-7
• 25 Ferraris V A, Gildengorin V. Predictors of excessive blood use after coronary artery bypass grafting.  J Thorac Cardiovasc Surg. 1989;  98 492-497
• 26 Giordano Sr G F, Giordano Jr G F, Rivers S L et al. Determinants of homologous blood usage utilizing autologous platelet-rich plasma in cardiac operations.  Ann Thorac Surg. 1989;  47 897-902
• 27 Kamran M, Ahmed A, Dar M I, Khan A B. Effect of aspirin on postoperative bleeding in coronary artery bypass grafting.  Ann Thorac Cardiovasc Surg. 2008;  14 (4) 224-229
• 28 Mangano D T. Multicenter study of perioperative ischemia research group. Aspirin and mortality from coronary artery bypass surgery.  N Engl J Med. 2002;  347 1309-1317
• 29 Chesebro J H, Clements I P, Fuster V et al. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency.  N Engl J Med. 1982;  307 (2) 73-78