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A prospective study of aspirin's effect on red blood cell loss in cardiac surgery
R E Rawitscher1, J W Jones, T A McCoy
1Toledo Hospital, Ritter Heart Institute, Ohio.
Insights
Patients taking aspirin before coronary artery bypass grafting (CABG) surgery did not experience increased red blood cell (RBC) loss or require more blood transfusions. Discontinuing aspirin is not necessary for elective CABG.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pharmacology
Background:
- Aspirin is commonly used for its antiplatelet effects.
- Concerns exist regarding aspirin's potential to increase bleeding and transfusion needs in patients undergoing major surgery, such as coronary artery bypass grafting (CABG).
- Preoperative aspirin cessation is often recommended, potentially delaying necessary cardiac procedures.
Purpose of the Study:
- To prospectively evaluate the impact of aspirin use on red blood cell (RBC) loss and the requirement for blood transfusions in patients undergoing elective CABG surgery.
- To determine if discontinuing aspirin is necessary before elective CABG.
Main Methods:
- A prospective study involving 100 consecutive patients undergoing elective CABG with normal bleeding times.
- Patients were divided into two groups: those taking 85-325 mg of aspirin daily up to 48 hours before surgery, and those not taking aspirin or who had stopped it at least 4 days prior.
- Red blood cell loss was quantified using RISA and 51Cr techniques, measuring preoperative and postoperative RBC volumes. Blood transfusion criteria were strictly defined.
Main Results:
- No significant differences were observed between the aspirin and no-aspirin groups in RBC loss (1158 ± 67 ml vs. 1129 ± 47 ml), chest tube drainage (925 ± 31 ml vs. 844 ± 70 ml), or discharge hemoglobin levels (9.94 ± 0.32 gm% vs. 9.49 ± 1.4 gm%).
- There were no significant differences in the units of blood transfused (1.32 ± vs. 1.21 ± 0.20 units) or the proportion of patients not receiving transfusions (44% vs. 50%).
- The study found no increased RBC loss or transfusion requirements in patients taking aspirin.
Conclusions:
- Continuing low-dose aspirin (85-325 mg) up to 48 hours before elective CABG surgery in patients with normal bleeding times does not lead to increased RBC loss or transfusion needs.
- These findings suggest that delaying elective CABG surgery solely for the purpose of discontinuing aspirin is not necessary.
- Patients on aspirin can safely undergo elective CABG without increased perioperative blood loss or transfusion requirements.
Abstract:
The effect of aspirin on red blood cell (RBC) loss and blood transfusions was evaluated prospectively in 100 consecutive patients, with normal bleeding times, undergoing elective coronary artery bypass (CABG) surgery. Patients taking 85-325 mgm of aspirin daily up to or within 48 hours of surgery (the "aspirin" group) were compared to patients not taking aspirin or those who had discontinued aspirin at least 4 days before surgery (the "no-aspirin" group). RBC loss was determined by measuring preoperative and postoperative RBC volume using RISA and 51Cr techniques. There were no significant differences, respectively, between the aspirin and no-aspirin groups for: RBC loss (1158 +/- 67 ml vs 1129 +/- 47 ml, p = 0.737), chest tube drainage (925 +/- 31 ml vs 844 +/- 70 ml, p = 0.553), and gm% discharge Hemoglobin (Hgb) (9.94 +/- 0.32 vs 9.49 +/- 1.4, p = 0.0148). Strict criteria for blood transfusions were employed: (1) intraoperative hematocrit of less than 21%, (2) postoperative Hgb of less than 7 gm% for patients less than 70 years old and (3) postoperative Hgb of less than 8 gm% for patients greater than 70 years old. There were no significant differences, respectively, between the aspirin and no-aspirin groups for units of blood transfused (1.32 +/- vs 1.21 +/- 0.20, p = 0.843) and patients not receiving transfusions during the entire hospitalization (44% vs 50%). Patients taking 85-325 mgm of aspirin with a normal bleeding time undergoing elective CABG did not have increased RBC loss or increased transfusion requirements. These results indicate it is not necessary to delay elective CABG surgery for the purpose of discontinuing aspirin.
