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Aspirin does not increase homologous blood requirements in elective coronary bypass surgery
D L Reich1, G C Patel, F Vela-Cantos
1Department of Anesthesiology, Mount Sinai Medical Center, New York, New York 10029-6574.
Insights
Aspirin (ASA) therapy increased bleeding in patients undergoing elective coronary artery bypass (CAB) surgery but did not raise the need for homologous blood transfusions, thanks to autologous cell salvaging techniques.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Hematology
Background:
- Previous studies indicated increased homologous blood product needs in patients on aspirin (ASA) undergoing cardiac surgery.
- Recent advancements in transfusion-sparing practices and autologous cell salvaging techniques may alter these outcomes.
Purpose of the Study:
- To reevaluate the impact of ASA therapy on hemorrhage and transfusion requirements in elective coronary artery bypass (CAB) surgery.
- To assess the efficacy of autologous blood reinfusion in mitigating potential increases in homologous blood product usage.
Main Methods:
- Retrospective review of 197 patients undergoing elective CAB surgery with autologous mediastinal blood reinfusion.
- Comparison between 87 patients on ASA pre-surgery and 110 control patients.
- Exclusion of patients undergoing repeat cardiac operations.
Main Results:
- No significant differences in cardiopulmonary bypass duration, procedure length, aortic cross-clamp time, or grafts between groups.
- Increased mediastinal tube drainage observed in the ASA group (27%), but this did not necessitate homologous blood transfusion due to autotransfusion.
- No significant differences in the use of platelets, fresh frozen plasma, or cryoprecipitate between the ASA and control groups.
Conclusions:
- Aspirin therapy does increase bleeding in patients undergoing elective CAB surgery.
- Autologous cell salvaging techniques effectively prevent increased homologous blood transfusion requirements despite heightened bleeding associated with ASA use.
Abstract:
Studies have demonstrated increased homologous blood product requirements in patients on aspirin (ASA) undergoing cardiac surgery. We reexamined the influence of ASA therapy on hemorrhage and transfusion requirements in patients undergoing elective coronary artery bypass (CAB) surgery in light of recent transfusion-sparing practices and autologous cell salvaging techniques. Records from 197 patients who underwent reinfusion of postoperatively shed mediastinal autologous whole blood were retrospectively reviewed, including 87 patients who received ASA within 1 wk prior to surgery and 110 control patients. Patients undergoing repeat cardiac operations were excluded from the study. Cardiopulmonary bypass (CPB) duration, procedure length, aortic cross-clamp time, and number of grafts performed did not differ significantly between groups. None of the patients required reexploration for bleeding. There was significantly more mediastinal tube drainage in the ASA group (27%), but it did not affect homologous blood component requirements because this blood was autotransfused. In addition, there were no significant differences in platelet, fresh frozen plasma, and cryoprecipitate use between the groups. Thus, ASA did increase bleeding but did not increase homologous blood transfusion requirements in elective CAB surgery.