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Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients
L J Dacey1, J J Munoz, E R Johnson
1Department of Surgery, Center for the Evaluative Clinical Sciences, Community & Family Medicine, Lebanon, New Hampshire, USA. lawrence.j.dacey@dartmouth.edu
Insights
Continuing aspirin before coronary artery bypass grafting (CABG) surgery was linked to lower mortality. This study found no increased bleeding risk in patients who took aspirin prior to CABG.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- Discontinuation of aspirin before coronary artery bypass grafting (CABG) primarily considers bleeding risks.
- The impact of preoperative aspirin on overall mortality following CABG has not been extensively investigated.
Purpose of the Study:
- To evaluate the association between preoperative aspirin use and in-hospital mortality in patients undergoing isolated CABG.
- To assess the effect of preoperative aspirin on bleeding complications and transfusion requirements in CABG patients.
Main Methods:
- A case-control study involving 8,641 isolated CABG procedures performed between July 1987 and May 1991.
- 368 deaths were identified as cases, each matched with approximately two control patients (survivors).
- Aspirin use was defined as ingestion within 7 days before the surgical procedure.
Main Results:
- Patients using preoperative aspirin showed a reduced likelihood of in-hospital mortality (multivariate OR = 0.55; 95% CI [0.31, 0.98]).
- No significant differences were observed in chest tube drainage, blood product transfusion, or reexploration for hemorrhage between aspirin users and non-users.
Conclusions:
- Preoperative aspirin use in CABG patients is associated with a decreased risk of mortality.
- This association was observed without a significant increase in hemorrhage, blood product requirements, or related morbidities.
Background:
Discontinuing aspirin use in patients before coronary artery bypass grafting (CABG) has focused on bleeding risks. The effect of aspirin use on overall mortality with this procedure has not been studied.
Methods:
We performed a case patient-control patient study of the 8,641 consecutive isolated CABG procedures performed between July 1987 and May 1991 in Maine, New Hampshire, and Vermont. Patients included all 368 deaths. Each case patient was paired with approximately two matched survivors (control patients). Aspirin use was defined by identification of ingestion within 7 days before the operation.
Results:
CABG patients using preoperative aspirin were less likely to experience in-hospital mortality in univariate (odds ratio [OR] = 0.73, 95% confidence interval [0.54, 0.97]) and multivariate [OR = 0.55, (0.31, 0.98)] analysis compared to nonusers. No significant difference was seen in the amount of chest tube drainage, transfusion of blood products, or need for reexploration for hemorrhage between patients who did and did not receive aspirin.
Conclusions:
Preoperative aspirin use appears to be associated with a decreased risk of mortality in CABG patients without significant increase in hemorrhage, blood product requirements, or related morbidities.
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