Related Experiment Videos
Blood loss after coronary artery bypass surgery: relations to patient variables and antithrombotic treatment
1Department of Thoracic Surgery, Karolinska Hospital, Stockholm, Sweden. staffan.bjessmo@swipnet.se
Insights
Acetylsalicylic acid (ASA) can be safely continued before coronary artery bypass surgery. This study found no increased bleeding risk in patients taking ASA, suggesting its continued use is feasible.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
Background:
- Coronary artery bypass surgery (CABS) involves significant blood loss.
- The use of antiplatelet agents like acetylsalicylic acid (ASA) in patients undergoing CABS requires careful consideration due to potential bleeding risks.
Purpose of the Study:
- To evaluate the safety of continuing acetylsalicylic acid (ASA) 75 mg/day until the day of isolated coronary artery bypass surgery.
- To assess the impact of ASA and other factors on blood loss during and after CABS.
Main Methods:
- Prospective study of 200 patients undergoing coronary artery bypass surgery.
- Analysis of blood loss, patient demographics, and pre-operative/intra-operative factors.
- Comparison of bleeding in patients receiving dalteparin/heparin for unstable angina and those taking ASA.
Main Results:
- Median blood loss was 500 ml during and 600 ml after surgery.
- Female gender and higher body mass index correlated with less postoperative bleeding.
- No significant increase in re-exploration for bleeding was observed in patients taking ASA.
Conclusions:
- Acetylsalicylic acid (ASA) 75 mg/day can be safely continued until the day of isolated coronary artery bypass surgery.
- Factors like female gender and BMI may influence postoperative bleeding, but ASA treatment did not significantly increase bleeding risk in this cohort.
Abstract:
Blood loss was studied in 200 patients during and after coronary artery bypass surgery. Half of the patients were receiving dalteparin/heparin treatment for unstable angina and taking acetylsalicylic acid (ASA) 75 mg/d. One stable and four unstable patients were re-explored because of postoperative bleeding (p = 0.17). Median blood loss was 500 ml (range 100-1700 ml) during the operation and 600 ml (range 200-3400 ml) after the operation. Regression analysis showed a correlation between less postoperative bleeding and female gender and larger body mass index. In our subset of patients this correlation was not predicted from unstable angina, ASA treatment, use of aprotinin, age or cardiopulmonary bypass time. The unstable patients had lower haemoglobin levels before the operation and received blood transfusions postoperatively more frequently. A total of 101 patients were given a blood transfusion. Our findings indicate that ASA can be safely continued until the day of isolated coronary artery bypass surgery.