Does Early Post-operative Administration of Aspirin Influence the Risk of Bleeding After Coronary Artery Bypass Graft Surgery? A Prospective Observational Study

Abstract

Background:Aspirin has a proven role in preventing thrombotic diseases. However, given its anti-platelet activity, it is often assumed that its early post-operative administration significantly increase the amount of post-operative bleeding.Aim:The aim of this study was to determine whether early post-operative administration of aspirin influence the risk of bleeding in patients undergoing coronary artery bypass graft (CABG) surgery.Methods:In a prospective observational study, 100 consecutive patients undergoing first time elective CABG surgery were include in the study. Patients received a low dose of aspirin (75-150 mg per day) either 1 hours (the early aspirin group; n=43) or 6 hours after surgery (the late aspirin group; n=57). Total mediastinal blood drainage, blood drainage after 6 hours, incidences of re-operation for the control of bleeding and transfusion of red blood cells (RBCs) and blood products were recorded and followed until chest tube removal.Results:The groups were found to be matched for the confounding variables and no significant differences were found between post-aspirin bleeding (p=0.37), RBCs and blood product usage (p=0.90) or incidences of re-operation for control of bleeding (p=1.00) between the two groups.Conclusions:Early administration (1 hour after surgery) of aspirin did not appear to increase the risk of post-operative bleeding in patients undergoing CABG. Thereby, its early administration in such cases may be considered. Although further well-designed randomized controlled trials to confirm the safety and efficacy of early administration of aspirin after CABG surgery are warranted.

American College of Veterinary Emergency and Critical Care (ACVECC) Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE) guidelines: Small animal

“…Five studies in human medicine (LOE 6, Good–Fair) provided evidence for guideline (a) in Section 5.10, which is based on an assessment of the likelihood of thrombosis compared to bleeding . High‐risk patients are more likely to be harmed by delays in administration of thromboprophylaxis than by mild postoperative bleeding .…”

Consensus on the Rational Use of Antithrombotics in Veterinary Critical Care (CURATIVE): Domain 5—Discontinuation of anticoagulant therapy in small animals

“…There is no evidence about the right approach in this situation in dogs and cats. In human patients with high thrombotic risk, anticoagulant or antiplatelet drugs should be started promptly when the patient is able to receive them (LOE 6, Good–Fair) . Based upon one case report in a dog developing postoperative thrombosis (LOE 5, Good), if postoperative thrombosis occurs, anticoagulant therapy should be started promptly.…”