A Meta-Analysis of Randomized and Observational Studies: Aspirin Protects from Cardiac Surgery-Associated Acute Kidney Injury
Related Experiment Video
Updated: Jan 21, 2026
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Huijiao Liu1, Jianwei Li1, Miaolian Chen1
1Department of Department of Critical Care Medicine, Zhongshan City People's Hospital, Zhongshan City, China.
Insights
Preoperative aspirin use before cardiac surgery may reduce acute kidney injury and mortality. However, most evidence comes from observational studies, necessitating further randomized trials to confirm safety and efficacy.
Area of Science:
- Cardiology
- Nephrology
- Surgical Outcomes
Background:
- Antiplatelet therapy is crucial for coronary artery disease management.
- Preoperative aspirin use in cardiac surgery presents a bleeding risk dilemma.
- Emerging evidence suggests aspirin may protect against cardiac surgery-associated acute kidney injury (CSA-AKI).
Purpose of the Study:
- To evaluate the efficacy of preoperative aspirin in preventing CSA-AKI.
- To assess the impact of preoperative aspirin on post-cardiac surgery outcomes.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OSs).
- Inclusion criteria: patients undergoing coronary artery bypass graft (CABG), valve replacement, or combined surgery.
- Outcomes assessed: CSA-AKI incidence, 30-day mortality, major adverse cardiocerebral events (MACE), and re-exploration for bleeding.
Main Results:
- Aspirin use within five days of cardiac surgery was associated with reduced post-operative renal failure (OR, 0.67; 95% CI, 0.50-0.89) and 30-day mortality (OR, 0.64; 95% CI, 0.53-0.77).
- Evidence suggests aspirin may protect against MACE (OR, 0.88; 95% CI, 0.76-1.01) without increasing bleeding re-exploration risk (OR, 1.01; 95% CI, 0.76-1.34).
Conclusions:
- Preoperative low-dose aspirin appears to decrease post-operative CSA-AKI, mortality, and MACE.
- The majority of included studies were observational, limiting definitive conclusions.
- Further high-quality randomized controlled trials are required to confirm the efficacy and safety of preoperative aspirin in cardiac surgery.
Background:
Antiplatelet therapy is critical in the management of coronary artery diseases. For patients undergoing cardiac surgeries, including coronary artery bypass graft (CABG) and valve replacement, controversy remains in preoperative antiplatelet therapy concerning risk of bleeding. For safety concern, aspirin is recommended to be withdrawn 5 to 10 days before a cardiac surgery. Recent studies, however, indicate that preoperative aspirin may have a protective effect on cardiac surgery-associated acute kidney injury (CSA-AKI).
Objective:
To estimate the efficacy of preoperative aspirin in preventing CSA-AKI.
Methods And Results:
Eligible studies included randomized controlled trials (RCTs) and observational studies (OSs) of patients, who had undergone CABG, valve replacement, or combined surgery. These studies compared preoperative aspirin with placebo/no aspirin and reported the least incidence of CSA-AKI. One RCT and five OSs met the inclusion criteria. Data retrieved suggested that aspirin prescribed within five days before cardiac surgery decreased post-operative renal failure [odds ratio (OR), 0.67; 95% confidence interval (CI), 0.50-0.89; P < 0.01] and 30-day mortality (OR, 0.64; 95% CI, 0.53-0.77; P < 0.01). One RCT and three OSs suggested aspirin protected from major adverse cardiocerebral events (MACE) (OR, 0.88; 95% CI, 0.76-1.01; P = 0.07). One RCT and two OSs suggested aspirin did not increase risk of re-exploration for bleeding (OR, 1.01; 95% CI, 0.76-1.34; P = 0.95).
Conclusion:
Preoperative low-dose aspirin decreases post-operative CSA-AKI, mortality, and MACE without increasing the risk of re-exploration. But most of the studies are observational. They lack a uniformed standard on prescription of aspirin and outcomes measurement. No stratification analysis is performed concerning different types of surgical procedures and comorbidities. More randomized controlled trials are necessary to confirm the efficacy and safety of preoperative aspirin prescription.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:22Acute Kidney Injury VI: Nursing Management
01:29Acute Kidney Injury III: Clinical Manifestations