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Published on: March 27, 2018
Perioperative aspirin and coronary artery bypass graft surgery: An updated meta-analysis of randomized controlled
Aashray K Gupta1, Ammar Zaka2, Alexander Lombardo3
1Discipline of Surgery, University of Adelaide, Adelaide, Australia.
Insights
Continuing aspirin before coronary artery bypass graft surgery showed no significant increase in mortality, heart attack, or bleeding risks. This systematic review of aspirin use in CABG patients found comparable outcomes whether aspirin was stopped or continued.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- The management of aspirin therapy before elective coronary artery bypass graft (CABG) surgery is debated due to balancing thrombotic and bleeding risks.
- Existing evidence is insufficient to definitively guide the decision on continuing or discontinuing aspirin pre-CABG.
Purpose of the Study:
- To conduct a contemporary systematic review and meta-analysis comparing outcomes in patients undergoing CABG who continued versus stopped aspirin preoperatively.
- To provide evidence-based guidance on aspirin management in the context of CABG surgery.
Main Methods:
- A systematic search of PubMed, MEDLINE, and CENTRAL databases was performed up to October 4, 2023.
- Included were randomized controlled trials comparing aspirin continuation versus discontinuation before CABG; observational studies and cointervention arms were excluded.
- Random effects models were used to calculate summary odds ratios for dichotomous and continuous outcomes, with subgroup and sensitivity analyses to address heterogeneity.
Main Results:
- Fifteen randomized controlled trials involving 6,188 patients were analyzed.
- Continuing aspirin was associated with no significant differences in all-cause mortality (OR, 1.37; 95% CI, 0.81-2.33), perioperative myocardial infarction (OR, 0.81; 95% CI, 0.55-1.18), or postoperative blood loss (MD, 66.12 mL; 95% CI, -1.45 to 133.69).
- No significant differences were found between low-dose and higher doses of aspirin; minimal heterogeneity was observed, though study quality was generally low.
Conclusions:
- This comprehensive meta-analysis indicates that continuing aspirin before CABG surgery does not significantly increase the risk of mortality, perioperative myocardial infarction, or postoperative bleeding.
- The findings suggest that current practice of stopping aspirin before CABG may not be necessary based on these outcomes.
- Further high-quality research may be warranted to confirm these findings, considering the low methodologic quality of included studies.
Background:
The decision to continue aspirin before elective coronary artery bypass graft surgery remains contentious because of competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between patients undergoing coronary artery bypass grafting who stopped and continued aspirin before surgery.
Methods:
PubMed, MEDLINE, and CENTRAL databases were searched from inception to 4 October 2023 for randomized controlled trials comparing patients undergoing coronary artery bypass grafting who continued preoperative aspirin with those who discontinued before surgery. Studies with cointervention arms and multivariable-adjusted or propensity matched observational studies were excluded. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity.
Results:
Fifteen eligible randomized controlled trials were included with a total of 6,188 patients. Patients who continued aspirin demonstrated no significant difference in all-cause mortality (odds ratio, 1.37; confidence interval, 0.81-2.33), perioperative myocardial infarction (odds ratio, 0.81; confidence interval, 0.55-1.18), and postoperative blood loss (mean difference, 66.12 mL; confidence interval, -1.45 to 133.69). No significant difference was observed between low-dose and greater doses of aspirin. There was minimal heterogeneity amongst included studies (I2 = 0%, P = .97, I2 = 33%, P = .13, and I2= 76, P = .06, respectively). Studies were of low methodologic quality according to Cochrane Risk of Bias for Randomized Trials.
Conclusions:
This largest to-date systematic review and meta-analysis found no significant difference for risk of all-cause mortality, perioperative myocardial infarction, and postoperative bleeding between patients continuing and stopping aspirin before coronary artery bypass grafting.
