The Effect of Aspirin on Bleeding and Transfusion in Contemporary Cardiac Surgery

Abstract

ObjectiveDespite evidence that preoperative aspirin improves outcomes in cardiac surgery, recommendations for aspirin use are inconsistent due to aspirin’s anti-platelet effect and concern for bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on bleeding and transfusion in cardiac surgery.MethodsThis retrospective study involved consecutive patients (n=1571) who underwent CABG, valve, or combined CABG and valve surgery at a single center between March 2007 and July 2012. Of all patients, 728 met the inclusion criteria and were divided into two groups: those using (n=603) or not using (n=125) aspirin within 5 days of surgery. Data were collected on chest tube drainage, re-operation for bleeding, and transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets.ResultsNo significant difference was observed between the two groups in chest tube drainage or re-operation for bleeding. An increase in patients transfused with RBCs was observed in the aspirin group (61.9 vs 51.2%, adjusted OR 1.77, p=0.027); however, among those transfused RBCs, no significant difference in mean units transfused or massive transfusion was observed. No significant difference was seen in transfusion requirement of FFP or platelets.ConclusionsIn patients undergoing CABG, valve, or combined CABG/valve surgery, preoperative aspirin, within 5 days of surgery, was associated with an increased probability of receiving an RBC transfusion. Preoperative aspirin was not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of FFP or platelets.

Aspirin before coronary artery surgery

“…This was a multicenter trial evaluating the effects of aspirin in patients undergoing coronary surgery. This study found no difference in the rates of bleeding complications or thromboembolic events, which contradict previous studies (2,3).…”

The use of preoperative aspirin in cardiac surgery: A systematic review and meta-analysis

“…Pooling the results of both RCTs and observational studies, preoperative aspirin did not show any substantial difference in the rates of surgical re‐exploration due to bleeding (OR 1.02; 95%CI 0.86‐1.21; P = 0.79; I 2 = 0 %; P heterogeneity = 0.83) (Figure ). The evidence was derived from the analysis of 26 146 patients, of who 94.11% underwent an isolated CABG, 0.61% underwent CABG +/− concomitant heart valve surgery, and 4.5% underwent valve surgery.…”

“…A total of 3922 patients from 12 RCTs and 30 893 patients coming from 28 observational studies met our inclusion criteria and were included in the meta‐analysis. Characteristics of the studies are presented in Tables and .…”

“…Nineteen observational studies reported PRBC transfusion rates. The analysis was based on the results from 18 392 patients.…”

Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study

“…Alternatively, studies have shown that aspirin improves oxygenation in cardiac surgery patients and attenuates cardiopulmonary bypass (CPB) induced lung injury, possibly by reducing thromboxane production [12,13]. Aspirin has also been associated with increased bleeding and transfusion risks in cardiac surgery and non-cardiac surgery patients, making its continued use during the perioperative period controversial [14,15]. We hypothesized that preoperative aspirin use might be associated with decreased pulmonary morbidity and mortality in massively transfused cardiac surgery patients.…”