Abstract:
BACKGROUND:The administration of aspirin is traditionally discontinued prior to coronary artery bypass grafting (CABG), given a potential risk of excessive postoperative bleeding. Few studies have previously suggested the benefits of continuing aspirin until the time of surgery. The primary aim of this review is to evaluate the effects of preoperative aspirin therapy on several clinically important outcomes in patients undergoing CABG. METHODS:A meta-analysis of eligible studies of patients undergoing CABG, reporting preoperative aspirin in comparison with no aspirin/placebo and our outcomes, was carried out. The safety outcomes included postoperative bleeding, packed red blood cell (PRBC) transfusion requirements, and reoperation for bleeding. The efficacy outcomes included perioperative myocardial infarction (MI), cerebrovascular accidents (CVAs), and mortality. RESULTS:In 8 randomized controlled trials (RCTs; n = 1538), preoperative aspirin increased postoperative bleeding (difference in means = 132.30 mL; 95 % confidence interval [CI] 47.10-217.51; P = .002), PRBC transfusion requirements (difference in means = 0.67 units; 95% CI 0.10-1.24; P = .02), and reoperation for bleeding (odds ratio [OR] = 1.76; 95% CI 1.05-2.93; P = .03). In 19 observational studies (n = 19551), preoperative aspirin increased postoperative bleeding (difference in means = 132.74 mL; 95% CI 45.77-219.72; P = .003) and PRBC transfusion requirements (difference in means = 0.19 units; 95% CI 0.02-0.35; P = .02) but not reoperation for bleeding (OR = 1.13; 95% CI 0.91-1.42; P = .27). Subgroup analyses for RCTs demonstrated that aspirin given at doses ≤ 100 mg/d might not increase the postoperative bleeding, and the dose of 325 mg/d might not be a cutoff value that has clinical and statistical significance. No statistically significant differences in the rate of perioperative MI, CVAs, or mortality were seen between the 2 groups. CONCLUSIONS:Preoperative aspirin therapy is associated with increased postoperative bleeding, PRBC transfusion requirements, and reoperation for bleeding in patients undergoing CABG. Doses lower than 100 mg/d may minimize the risk of bleeding. Additional RCTs are needed to assess the effects of preoperative aspirin on the safety and efficacy outcomes in patients undergoing CABG.
journal_name
J Cardiovasc Pharmacol Therjournal_title
Journal of cardiovascular pharmacology and therapeuticsauthors
Ma X,Ma C,Yun Y,Zhang Q,Zheng Xdoi
10.1177/1074248413509026subject
Has Abstractpub_date
2014-01-01 00:00:00pages
97-113issue
1eissn
1074-2484issn
1940-4034pii
1074248413509026journal_volume
19pub_type
杂志文章,meta分析,评审abstract::A large body of evidence indicates that a persistently high heart rate is associated with a significant risk for higher mortality and sudden death in individuals with a variety cardiovascular disorders, as well as in the general population. Heart rates elevated beyond a certain threshold have been found to be a risk f...
journal_title:Journal of cardiovascular pharmacology and therapeutics
pub_type: 杂志文章,评审
doi:10.1177/107424840200700208
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journal_title:Journal of cardiovascular pharmacology and therapeutics
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journal_title:Journal of cardiovascular pharmacology and therapeutics
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journal_title:Journal of cardiovascular pharmacology and therapeutics
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