COMPARISON OF OUTCOME WITH OR WITHOUT ASPIRIN IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY

H IQBAL; W KHALID; T INAM; M AAMIR

doi:10.54112/bcsrj.v2022i1.138

Authors

H IQBAL Department of cardiac surgery, Rehmatul Lil Alameen Institute of Cardiology(RAIC), Lahore- Pakistan
W KHALID Department of cardiac surgery, Rehmatul Lil Alameen Institute of Cardiology(RAIC), Lahore- Pakistan
T INAM Department of Anatomy, kind Edward Medical University (KEMU) Lahore- Pakistan
M AAMIR Department of cardiac surgery, Jinnah Hospital, Lahore-Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2022i1.138

Keywords:

Aspirin, Perioperative MI, Postoperative bleeding, Coronary artery bypass grafting

Abstract

Preoperative use of aspirin in coronary artery bypass graft surgery (CABG) might rely more on surgeon’s preference rather than on evidence-based approach. Conflicting guidelines and lack of reliable recommendations make ambiguous the preoperative aspirin administration before elective CABG. This study was conducted to compare the outcome with or without aspirin in patients undergoing coronary artery bypass surgery. The aim of the study was to compare the outcome with or without aspirin in patients undergoing coronary artery bypass surgery. This Randomized controlled trial was conducted at the Department of Cardiac Surgery, AFIC/ NIHD, Rawalpindi from 11^th Dec 2018 to 10^th June 2019. One hundred and fifty patients fulfilling inclusion criteria underwent through CABG were divided into two groups. In group A, 75 patients continued aspirin, while in group B, aspirin was stopped 5 days before surgery. Patient’s demographic features, comorbid conditions, Postoperative bleeding, perioperative MI and need for blood transfusion were noted. The mean age and BMI of patients were 61.41 ± 3.09 and 63.96 ± 7.64 years and 28.98 ± 2.46 and 32.61 ± 1.98 Kg/m2 in group A and B, respectively. Male to female ratios were 3.41:1 and 4.35:1 in group A and B, respectively. Diabetes and hypertension were seen in 67(89.34%) and 59(78.67%) patients and 69(90.67%) and 70(93.34%) patients in group A and B, respectively. Perioperative MI and blood transfusion were statistically significant among both groups (5.34% vs. 9.34% patients; p=0.0001 and 5.34% vs. 1.34%; p=0.0003). Mean postoperative bleeding was 401.39 ± 121.04 and 389.21 ± 101.13 ml/24 hr. in group A and B, respectively. The continuation of aspirin therapy in patients undergoing elective CABG reduces perioperative MI, increases quantity of postoperative bleeding and need for blood transfusion. There is a significant difference in outcome with or without aspirin in patients undergoing coronary artery bypass surgery.

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References

Aboul-Hassan, S. S., Stankowski, T., Marczak, J., Peksa, M., Nawotka, M., Stanislawski, R., and Cichon, R. (2020). Timing strategy of preoperative aspirin and its impact on early outcomes in patients undergoing coronary artery bypass grafting: a propensity score matching analysis. Journal of Surgical Research246, 251-259. DOI: https://doi.org/10.1016/j.jss.2019.09.026

Columbo, J. A., Lambour, A. J., Sundling, R. A., Chauhan, N. B., Bessen, S. Y., Linshaw, D. L., Kang, R., Riblet, N. B., Goodney, P. P., and Stone, D. H. (2018). A meta-analysis of the impact of aspirin, clopidogrel, and dual antiplatelet therapy on bleeding complications in noncardiac surgery. Annals of surgery267, 1-10. DOI: https://doi.org/10.1097/SLA.0000000000002279

DeFilippis, A. P., Trainor, P. J., Thanassoulis, G., Brumback, L. C., Post, W. S., Tsai, M. Y., and Tsimikas, S. (2022). Atherothrombotic factors and atherosclerotic cardiovascular events: the multi-ethnic study of atherosclerosis. European heart journal43, 971-981. DOI: https://doi.org/10.1093/eurheartj/ehab600

Filipescu, D. C., Stefan, M. G., Valeanu, L., and Popescu, W. M. (2020). Perioperative management of antiplatelet therapy in noncardiac surgery. Current Opinion in Anesthesiology33, 454-462. DOI: https://doi.org/10.1097/ACO.0000000000000875

Gao, J., Liu, Y., and Li, Y.-M. (2018). Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting. Journal of International Medical Research46, 4907-4919. DOI: https://doi.org/10.1177/0300060518792445

Gelbenegger, G., Postula, M., Pecen, L., Halvorsen, S., Lesiak, M., Schoergenhofer, C., Jilma, B., Hengstenberg, C., and Siller-Matula, J. M. (2019). Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups. BMC medicine17, 1-16. DOI: https://doi.org/10.1186/s12916-019-1428-0

Gielen, C. L., Bruggemans, E. F., Stijnen, T., Eikenboom, J., Tavilla, G., Brand, A., and Klautz, R. J. (2015). Stopping antiplatelet medication before coronary artery bypass graft surgery: is there an optimal timing to minimize bleeding? European Journal of Cardio-Thoracic Surgery48, e64-e70. DOI: https://doi.org/10.1093/ejcts/ezv269

Hanalioglu, S., Sahin, B., Sahin, O. S., Kozan, A., Ucer, M., Cikla, U., Goodman, S. L., and Baskaya, M. K. (2019). Effect of perioperative aspirin use on hemorrhagic complications in elective craniotomy for brain tumors: results of a single-center, retrospective cohort study. Journal of Neurosurgery132, 1529-1538. DOI: https://doi.org/10.3171/2018.12.JNS182483

Jacob, M., Smedira, N., Blackstone, E., Williams, S., and Cho, L. (2011). Effect of timing of chronic preoperative aspirin discontinuation on morbidity and mortality in coronary artery bypass surgery. Circulation123, 577-583. DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.957373

Myles, P. S., Smith, J. A., Forbes, A., Silbert, B., Jayarajah, M., Painter, T., Cooper, D. J., Marasco, S., McNeil, J., and Bussières, J. S. (2016). Stopping vs. continuing aspirin before coronary artery surgery. New England Journal of Medicine374, 728-737. DOI: https://doi.org/10.1056/NEJMoa1507688

Palamaras, I., and Semkova, K. (2015). Perioperative management of and recommendations for antithrombotic medications in dermatological surgery. British Journal of Dermatology172, 597-605. DOI: https://doi.org/10.1111/bjd.13362

Rothwell, P. M., Wilson, M., Price, J. F., Belch, J. F., Meade, T. W., and Mehta, Z. (2012). Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials. The Lancet379, 1591-1601. DOI: https://doi.org/10.1016/S0140-6736(12)60209-8

Sembi, N., Cheng, T., Ravindran, W., Ulucay, E., Ahmed, A., and Harky, A. (2021). Anticoagulation and antiplatelet therapy post coronary artery bypass surgery. Journal of Cardiac Surgery36, 1091-1099. DOI: https://doi.org/10.1111/jocs.15283

Solo, K., Lavi, S., Kabali, C., Levine, G. N., Kulik, A., John-Baptiste, A. A., Fremes, S. E., Martin, J., Eikelboom, J. W., and Ruel, M. (2019). Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis. bmj367. DOI: https://doi.org/10.1136/bmj.l5476

Van Oosterom, N., Barras, M., Cottrell, N., and Bird, R. (2022). Platelet function assays for the diagnosis of aspirin resistance. Platelets33, 329-338. DOI: https://doi.org/10.1080/09537104.2021.1942816

Walker, J., Hutchison, P., Ge, J., Zhao, D., Wang, Y., Rothwell, P. M., Gaziano, J. M., Chan, A., Burn, J., and Chia, J. (2018). Aspirin: 120 years of innovation. A report from the 2017 Scientific Conference of the International Aspirin Foundation, 14 September 2017, Charité, Berlin. ecancermedicalscience12. DOI: https://doi.org/10.3332/ecancer.2018.813

Ward, C. M., Andrews, R. K., Speakers, I. S. o. t. A., Barco, S., Battinelli, E., Boilard, E., Bos, M. H., Chicanne, G., Chuansumrit, A., and Conway, E. M. (2019). Illustrated state‐of‐the‐art capsules of the ISTH 2019 congress in Melbourne, Australia. Research and Practice in Thrombosis and Haemostasis3, 431-497. DOI: https://doi.org/10.1002/rth2.12225