Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes following Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Sharifi, Mehrzad; Kamali, Alireza; Ghandi, Yazdan

doi:10.1055/s-0037-1608686

Cited by 4 publications

(6 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In one RCT, CABG patients (n ¼ 206) received aspirin treatment that was either continued until the day of surgery or stopped 4 days earlier. 312 Rates of bleeding and transfusion of RBCs were significantly higher in patients receiving aspirin until the day of surgery (P < 0.001), and there were no significant differences in postoperative myocardial infarction or stroke. Nevertheless, the ATACAS randomised trial, conducted in 2100 patients undergoing coronary artery surgery, concluded differently as the administration of pre-operative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding, including re-operation for haemorrhage, than observed with placebo.…”

Section: Evidence Summarymentioning

confidence: 86%

“…Aspirin treatment was associated with increased chest tube drainage ( P = 0.011), although the risk of re-operation due to bleeding was not significantly increased. In one RCT, CABG patients ( n = 206) received aspirin treatment that was either continued until the day of surgery or stopped 4 days earlier 312 . Rates of bleeding and transfusion of RBCs were significantly higher in patients receiving aspirin until the day of surgery ( P < 0.001), and there were no significant differences in postoperative myocardial infarction or stroke.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

108

View full text Add to dashboard Cite

BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

show abstract

Section: Evidence Summarymentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

108

View full text Add to dashboard Cite

show abstract

“…Four hundred nineteen duplicates were removed; the remaining 2408 studies were screened by title and abstract. Eighty‐one studies were identified for full‐text review; finally, 56 RCTs 15–70 comprising 61 894 patients in total were included in this study (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…In the 2017 EACTS Guidelines on Preoperative Medication in Adult Cardiac Surgery, 11 aspirin usage is recommended in the preoperative and postoperative periods (class IIA and class I recommendation respectively). From the perspective of stroke prevention, there was no significant difference between administration of preoperative aspirin versus its discontinuation 40,41 . Given the benefits of aspirin continuation in reducing postoperative MI, 71 this strategy is recommended unless the patient is at high risk of bleeding or refuses blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

Stroke prevention strategies for cardiac surgery: a systematic review and meta‐analysis of randomized controlled trials

Fong,

Yeo,

Luo

et al. 2024

ANZ Journal of Surgery

View full text Add to dashboard Cite

BackgroundStroke is a much‐feared complication of cardiac surgery, but existing literature on preventive strategies is fragmented. Hence, a systematic review and meta‐analysis of stroke prevention strategies for cardiac surgery was conducted.MethodsAn electronic literature search was conducted to retrieve randomized controlled trials (RCTs) investigating perioperative interventions for cardiac surgery, with stroke as an outcome. Random‐effects meta‐analyses were conducted to generate risk ratios (RRs), 95% confidence intervals (95% CI), and forest plots. Descriptive analysis and synthesis of literature was conducted for interventions not amenable to meta‐analysis, focusing on risks of stroke, myocardial infarction and study‐defined major adverse cardiovascular events (MACE).ResultsFifty‐six RCTs (61 894 patients) were retrieved. Many included trials were underpowered to detect differences in stroke risk. Among pharmacological therapies, only preoperative amiodarone was shown to reduce stroke risk in one trial. Concomitant left atrial appendage closure (LAAC) significantly reduced stroke risk (RR = 0.55, 95% CI = 0.36–0.84, P = 0.006) in patients with preoperative atrial fibrillation, and there was no difference in on‐pump versus off‐pump coronary artery bypass grafting (CABG) (RR = 0.94, 95% CI = 0.64–1.37, P = 0.735). Much controversy exists in literature on the timing of carotid endarterectomy relative to CABG in patients with severe carotid stenosis. The use of preoperative remote ischemic preconditioning was not found to reduce rates of stroke or MACE.ConclusionThis review presents a comprehensive synthesis of existing interventions for stroke prevention in cardiac surgery, and identifies gaps in research which may benefit from future, large‐scale RCTs. LAAC should be considered to reduce stroke incidence in patients with preoperative atrial fibrillation.

show abstract

“…Sustained ingestion until the day of surgery in elective can result in excessive bleeding, increased rate of reexploration, and need for more transfusions. 38 A recent comparative study of patients undergoing surgery without the use of extracorporeal circulation with or without discontinuing aspirin preoperatively showed a similar incidence of complications associated with haemorrhage. 39 Interruption of aspirin administration is no longer suggested.…”

Section: Discussionmentioning

confidence: 98%

The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases

Prapas

Pangiotopoulos

Leivaditis

et al. 2019

Open�J Cardiovasc Surg

View full text Add to dashboard Cite

Coronary artery bypass surgery still has its unique role in the treatment of coronary artery disease. It faces, however, the continuous challenge of becoming even less invasive and more effective as cases become more complex. We here present the results of 1359 cases treated with the π-circuit technique which consists of an off-pump total myocardial revascularization using composite arterial grafts. The results demonstrate that it is a safe technique providing low mortality, stroke, renal failure, wound infection, and other complication rates. We suggest the application of this technique, as well as of other similar techniques regarding similar principles, especially in high-risk patients.

show abstract

Effect of Sustained Use of Aspirin until the Time of Surgery on Outcomes following Coronary Artery Bypass Grafting: A Randomized Clinical Trial

Cited by 4 publications

References 38 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Stroke prevention strategies for cardiac surgery: a systematic review and meta‐analysis of randomized controlled trials

The π-Circuit Technique in Coronary Surgery: Analysis of 1359 Consecutive Cases

Contact Info

Product

Resources

About