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

Aboul-Hassan, Sleiman Sebastian; Stankowski, Tomasz; Marczak, Jakub; Pęksa, Maciej; Nawotka, Marcin; Stanisławski, Ryszard; Kryszkowski, Bartosz; Cichoń, Romuald

doi:10.1111/jocs.13250

Cited by 35 publications

(25 citation statements)

References 61 publications

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“…In a study, Lawrence et al 5 performed revision surgery due to bleeding in 3.6% of the patients, consistent with our findings. Although revision surgery due to bleeding in the postoperative period has been associated with increased mortality 6 , we observed no mortality in patients who underwent revision surgery.…”

Section: Discussioncontrasting

confidence: 55%

“…In addition, a transient loss of platelet function can be seen after CABG under CPB 7 . However, preoperative antiaggregant use, particularly acetylsalicylic acid has not been associated with postoperative bleeding requiring revision surgery with a mortality-reducing effect 6 . Therefore, in our study, all patients were given premedication on the night before surgery and were operated under acetylsalicylic acid treatment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Our Early Results of Isolated Coronary Artery Bypass Grafting: A Case Series of The First 100 Patients In a Newly Established Heart Center

Aydın¹,

Bademci²,

Kocaaslan³

et al. 2019

MMJ

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In this study, we aimed to investigate the early results of the first 100 patients who underwent isolated elective coronary artery bypass surgery because of coronary artery disease in our clinic. Methods: The first 100 patients who underwent isolated elective coronary artery bypass surgery between October 2016-January 2018 were included. İn the study routine blood tests, echocardiography, electrocardiography, chest X-ray, carotid-vertebral artery doppler ultrasound, pulmonary function tests were performed and nasal culture was obtained preoperatively. Euroscore II scoring system was used for calculating the mortality risk. All operations were performed under intrathoracic general anesthesia. Using median sternotomy approach, ascending aortic cannulation, unicaval venous cannulation, intermittent antegrade cold blood cardioplegia and under mild hypothermia cardiopulmonary bypass were performed. Results: Median age was 58 years and 35% (n=35) of the patients were female. Most common preoperative risk factors were hypertension (HT) (50%; n=50) and smoking (42%; n=42). Mean cardiopulmonary bypass time was 70±13 minutes, mean cross-clamp time was 40±16 minutes, mean number of revascularized coronary arteries was 3.4±1.0. Postoperative atrial fibrillation was detected in 22% (n=22) of the patients, and all patients were converted to sinüs ritm with medical treatments. In hospital mortality was 2% (n=2). Conclusion: Surgical treatment of isolated coronary artery disease, especially in low-risk patient group, remains in the current treatment guidelines with low mortality and morbidity rates.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Our Early Results of Isolated Coronary Artery Bypass Grafting: A Case Series of The First 100 Patients In a Newly Established Heart Center

Aydın¹,

Bademci²,

Kocaaslan³

et al. 2019

MMJ

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“…23,24 Further, the 2017 meta-analysis found a slightly higher rate of RBC transfusion in patients with continued aspirin administration but no difference in chest drainage output or incidence of repeat thoracotomy. 21 In contrast, the ATACAS trial found no change in bleeding risk due to continued aspirin intake. 23 The latter might, at least partially, be explained by the use of antifibrinolytics in the ATACAS study.…”

Section: Aspirinmentioning

confidence: 98%

“…Modified after Bolliger et al 20 and Mahla et al 12 studies including nearly 30,000 patients undergoing cardiac surgery (>89% CABG surgery), the use of preoperative aspirin was associated with reductions in early mortality, acute kidney injury, and myocardial infarction. 21 The positive effects of preoperative aspirin were mainly driven by observational studies. A more recent retrospective propensity score analysis suggested that discontinuing aspirin before CABG surgery might increase mortality and major thromboembolic events by more than 50%.…”

Section: Aspirinmentioning

confidence: 99%

Point-of-Care Platelet Function Monitoring: Implications for Patients With Platelet Inhibitors in Cardiac Surgery

Bolliger

Lancé

Siegemund

2021

Journal of Cardiothoracic and Vascular Anesthesia

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Although most physicians are comfortable managing the limited anticoagulant effect of aspirin, the recent administration of potent P2Y 12 receptor inhibitors in patients undergoing cardiac surgery remains a dilemma. Guidelines recommend discontinuation of potent P2Y 12 inhibitors 5-to-7 days before surgery to reduce the risk of postoperative hemorrhage. Such a strategy might not be feasible before urgent surgery, due to ongoing myocardial ischemia or in patients at high risk for thromboembolic events. Recently, different point-of-care devices to assess functional platelet quality have become available for clinical use. The aim of this narrative review was to evaluate the implications and potential benefits of platelet function monitoring in guiding perioperative management and therapeutic options in patients treated with antiplatelets, including aspirin or P2Y 12 receptor inhibitors, undergoing cardiac surgery. No objective superiority of one point-of-care device over another was found in a large meta-analysis. Their accuracy and reliability are generally limited in the perioperative period. In particular, preoperative platelet function testing has been used to assess platelet contribution to bleeding after cardiac surgery. However, predictive values for postoperative hemorrhage and transfusion requirements are low, and there is a significant variability between and within these tests. Further, platelet function monitoring has been used to optimize the preoperative waiting period after cessation of dual antiplatelet therapy before urgent cardiac surgery. Furthermore, studies assessing their value in therapeutic decisions in bleeding patients after cardiac surgery are scarce. A general and liberal use of perioperative platelet function testing is not yet recommended.

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“…4 The use of an antiplatelet agent, such as aspirin, either before and immediately after surgery, was an attempt to reduce the consequences of a problem that could lead to occlusion of grafts, mainly venous. It was demonstrated that aspirin reduces early mortality and incidence of acute myocardial infarction 5 and improves patency rate after CABG. 6 Aspirin, however, has some drawbacks.…”

mentioning

confidence: 99%

Commentary: Better late than never!

Calafiore¹,

Mauro

2019

The Journal of Thoracic and Cardiovascular Surgery

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

Cited by 35 publications

References 61 publications

Our Early Results of Isolated Coronary Artery Bypass Grafting: A Case Series of The First 100 Patients In a Newly Established Heart Center

Our Early Results of Isolated Coronary Artery Bypass Grafting: A Case Series of The First 100 Patients In a Newly Established Heart Center

Point-of-Care Platelet Function Monitoring: Implications for Patients With Platelet Inhibitors in Cardiac Surgery

Commentary: Better late than never!

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