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Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting
V A Ferraris1, S P Ferraris, F C Lough
1Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700.
Insights
Preoperative aspirin use significantly increases blood loss and transfusion needs after coronary artery bypass grafting (CABG). Discontinuing aspirin before cardiac surgery is recommended to reduce these risks.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Aspirin is commonly used for its antiplatelet effects.
- Its impact on blood loss and transfusion needs in cardiac surgery is critical to understand.
Purpose of the Study:
- To evaluate the effect of preoperative aspirin ingestion on postoperative blood loss.
- To assess the impact on transfusion requirements following coronary artery bypass grafting (CABG).
Main Methods:
- A non-blinded, randomized study involving 34 patients undergoing CABG.
- Patients were divided into aspirin-treated and control groups.
- Blood loss and transfusion requirements were meticulously monitored.
Main Results:
- Aspirin group showed significantly higher chest-tube blood loss (1,513 vs. 916 ml).
- Increased requirements for packed red blood cells, platelets, and fresh-frozen plasma transfusions in aspirin users.
- Two patients requiring reoperation for bleeding were in the aspirin group.
Conclusions:
- Preoperative aspirin ingestion is associated with increased postoperative blood loss and transfusion needs in CABG patients.
- A subset of patients may exhibit heightened sensitivity to aspirin, leading to prolonged bleeding times.
- Discontinuation of aspirin therapy before cardiac procedures is advised.
Abstract:
Thirty-four patients were entered into a non-blinded, randomized study to test the effect of preoperative aspirin ingestion on postoperative blood loss and transfusion requirements after coronary artery bypass grafting. Sixteen patients in the aspirin-treated group had significantly increased chest-tube blood loss 12 hours after operation (1,513 +/- 978 versus 916 +/- 482 ml; p = 0.038). In addition, aspirin users had significantly increased requirements for postoperative packed red blood cells (4.4 +/- 3.5 versus 1.8 +/- 1.3 units; p = 0.014), platelets (1.3 +/- 1.3 versus 0.2 +/- 0.4 six-donor units, p = 0.0049), and fresh-frozen plasma (3.6 +/- 5.0 versus 0.78 +/- 1.6 units; p = 0.042) transfusions. The only patients requiring reoperation for bleeding were in the aspirin-treated group (2 patients). Six patients were not entered into the randomized part of the study because of excessively prolonged post-aspirin bleeding times (greater than 10 minutes). This finding suggests that a subset of patients are particularly sensitive to aspirin and have significantly prolonged bleeding times after aspirin ingestion. We conclude that aspirin ingestion increases postoperative blood loss and transfusion requirements, and we recommend discontinuation of aspirin therapy before cardiac procedures.