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Published on: March 27, 2018
The Effects of Preoperative Aspirin on Coronary Artery Bypass Surgery: a Systematic Meta-Analysis
Doyeon Hwang1, Joo Myung Lee2, Tae Min Rhee1
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
Insights
Preoperative aspirin use in coronary artery bypass graft surgery (CABG) increases chest tube drainage but does not raise bleeding re-operation risks. It also does not reduce early mortality or myocardial infarction rates.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Aspirin is crucial for graft patency and preventing thrombosis post-coronary artery bypass graft (CABG) surgery.
- The benefit of preoperative aspirin is debated due to potential bleeding risks.
Purpose of the Study:
- To systematically evaluate the impact of preoperative aspirin on clinical outcomes after CABG.
- To assess the association between preoperative aspirin and bleeding complications, mortality, and myocardial infarction.
Main Methods:
- A meta-analysis of 17 studies (12 RCTs, 5 registries) involving 9,101 patients undergoing CABG.
- Data extraction by two independent reviewers.
- Random effects model employed for meta-analysis.
Main Results:
- Preoperative aspirin significantly increased chest tube drainage (177.4 mL).
- No significant difference in re-operation for bleeding risk (3.2% vs. 2.4%; OR 1.23, p=0.102).
- No significant difference in all-cause mortality (1.6% vs. 1.5%; OR 0.98, p=0.920) or myocardial infarction (8.7% vs. 10.4%; OR 0.83, p=0.102).
Conclusions:
- Preoperative aspirin increases chest tube drainage but not the risk of re-operation for bleeding.
- Early postoperative mortality and myocardial infarction rates were not reduced by preoperative aspirin administration.
Background And Objectives:
Aspirin plays an important role in the maintenance of graft patency and the prevention of thrombotic event after coronary artery bypass graft surgery (CABG). However, the use of preoperative aspirin is still under debate due to the risk of bleeding.
Methods:
From PubMed, EMBASE, and Cochrane Central Register of Controlled Trials, data were extracted by 2 independent reviewers. Meta-analysis using random effect model was performed.
Results:
We performed a systemic meta-analysis of 17 studies (12 randomized controlled studies and 5 non-randomized registries) which compared clinical outcomes of 9,101 patients who underwent CABG with or without preoperative aspirin administration. Preoperative aspirin increased chest tube drainage (weighted mean difference 177.4 mL, 95% confidence interval [CI], 41.3-313.4; p=0.011). However, the risk of re-operation for bleeding was not different between the preoperative aspirin group and the control group (3.2% vs. 2.4%; odds ratio [OR], 1.23; 95% CI, 0.94-1.60; p=0.102). There was no difference in the rates of all-cause mortality (1.6% vs. 1.5%; OR, 0.98; 95% CI, 0.64-1.49; p=0.920) and myocardial infarction (MI) (8.7% vs. 10.4%; OR, 0.83; 95% CI, 0.66-1.04; p=0.102) between patients with and without preoperative aspirin administration.
Conclusions:
Although aspirin increased the amount of chest tube drainage, it was not associated with increased risk of re-operation for bleeding. In addition, the risks of early postoperative all-cause mortality and MI were not reduced by using preoperative aspirin.
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