Related Experiment Videos
Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery
K J Tuman1, R J McCarthy, C J O'Connor
1Department of Anesthesiology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Insights
Preoperative aspirin (ASA) therapy does not increase blood transfusions or drainage in reoperative coronary artery bypass grafting (CABG) surgery. Patient and surgical factors, not ASA, are key predictors of transfusion needs.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Transfusion Medicine
Background:
- Preoperative aspirin (ASA) is common, but its effect on bleeding in high-risk cardiac surgery, like reoperative coronary artery bypass grafting (CABG), is unclear.
- Previous studies suggest ASA doesn't increase transfusion in primary CABG, but data for repeat CABG is limited.
Purpose of the Study:
- To investigate the impact of preoperative aspirin (ASA) consumption on mediastinal drainage and allogeneic transfusion in patients undergoing reoperative CABG.
- To identify predictors of mediastinal drainage and blood product transfusion in this patient population.
Main Methods:
- A retrospective study of 317 patients undergoing reoperative CABG, comparing those who took ASA within 7 days preoperatively (n=215) with a control group (n=102).
- All patients received aminocaproic acid; other blood-saving strategies were not used.
- Mediastinal drainage, hematocrit, and allogeneic blood product transfusion (packed red blood cells, fresh frozen plasma, platelets, cryoprecipitate) were analyzed.
Main Results:
- No significant differences in postoperative hematocrit, mediastinal drainage, reexploration rates, or allogeneic blood product transfusion volumes were observed between ASA and control groups.
- Multivariate analysis identified duration of cardiopulmonary bypass (CPB), internal mammary artery harvesting, steroid therapy, and intraaortic balloon pump (IABP) use as predictors of mediastinal drainage.
- Female gender, prolonged CPB duration, advanced age, IABP use, and lack of smoking history predicted blood product transfusion.
Conclusions:
- Preoperative aspirin ingestion is not a significant determinant of mediastinal drainage or allogeneic transfusion in reoperative CABG surgery.
- Surgical factors (CPB duration, IABP, artery harvesting) and patient characteristics (age, gender, smoking history) are more important predictors of bleeding and transfusion outcomes.
Abstract:
While preoperative aspirin (ASA) therapy does not increase allogeneic transfusion in elective primary coronary artery bypass grafting (CABG) operations, the impact of ASA consumption on transfusion in cardiac operations with greater risk of bleeding has not been investigated. We examined the influence of ASA consumption on mediastinal drainage and allogenic transfusion in 317 patients undergoing reoperative CABG surgery. Patients receiving ASA or ASA containing medications within 7 days preoperatively (n = 215) had similar perioperative characteristics but were older and had smaller red cell volumes than control patients not receiving ASA (n = 102). All patients received aminocaproic acid, but autotransfusion of mediastinal blood or platelet rich plasma, aprotinin, or desmopressin were not used. No significant differences were observed between ASA and control groups with respect to postoperative hematocrit, mediastinal drainage, frequency of reexploration for excessive bleeding, amount of allogeneic packed red blood cell, fresh frozen plasma, platelet concentrate or cryoprecipitate transfusion, or the fraction of patients receiving any allogeneic blood product. There was no difference in mediastinal drainage when stratified by timing of most recent ASA ingestion. Multiple linear regression identified duration of cardiopulmonary bypass (CPB), internal mammary artery harvesting, chronic preoperative steroid therapy and use of an intraaortic balloon pump (IABP) as significant predictors of mediastinal drainage. Logistic regression demonstrated that female gender, prolonged duration of CPB, advanced age, use of IABP, and a negative history of smoking were significant independent predictors of blood product transfusion. There was no significant interaction of preoperative heparin therapy with ASA on transfusion demonstrated by univariate or multivariate analyses. These results indicate that preoperative ASA ingestion is not an important determinant of mediastinal drainage or allogeneic transfusion, even after repeat CABG operations, and that surgical and patient characteristics are more important predictors of these outcomes.