Aspirin Does Not Increase Homologous Blood Requirements in Elective Coronary Bypass Surgery

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.

A randomised controlled pilot trial to evaluate and optimize the use of anti-platelet agents in the perioperative management in patients undergoing general and abdominal surgery—the APAP trial (ISRCTN45810007)

“…There were no significant differences between the study groups to haemorrhage in most procedures, with the exception of intracranial neurosurgery and possibly transurethral prostatectomy. As for transfusion rates, available data vary from "no significant differences between ASA-treated patients and controls" in cardiac surgery [53,54] to an "average increase of 30% in transfusion rate" in interdisciplinary review articles [24]. The complication rate of red blood cell transfusion has, however, been calculated to be only 0.4% [55].…”

Modified thromboelastography evaluation of platelet dysfunction in patients undergoing coronary artery surgery

“…Although the Perioperative Blood Conservation Guidelines of the Society of Thoracic Surgeons/Society of Cardiovascular Anesthesiologists call for discontinuation of aspirin treatment in elective patients [2], several studies have failed to find increased perioperative blood loss or transfusion requirements in patients undergoing first-time or even repeated coronary artery surgery [22,23]. In a large retrospective study demonstrating the effect of aspirin on transfusion requirements, this effect was observed in only one quintile of patients (namely, those with the longest cardiopulmonary bypass times, greater number of women, repeated operations and more prevalent preoperative renal dysfunction) [24].…”

A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery

“…15,28 It should be noted, however, that several studies using strict transfusion criteria have demonstrated that preoperative aspirin does not increase allogeneic transfusion in elective primary or reoperative coronary artery surgery. 29,30 Standardized transfusion practice There is increasing evidence that postoperative blood transfusion should be guided by clinical indications and not only by specific hematocrit or hemoglobin values. 1,4,[31][32][33] In the present study, the use of clinical judgement as the main transfusion trigger resulted in a 50% decrease in allogeneic blood utilisation.…”