title: Timing of preoperative aspirin discontinuation and outcome after elective coronary artery bypass graft surgery.
abstract: OBJECTIVE
  Whether aspirin should be discontinued before coronary artery bypass grafting is controversial. The potential benefits and harms associated with late use of aspirin (no discontinuation or discontinuation <3 days before surgery) were investigated in this retrospective, multicenter study.
  
  
  METHODS
  Retrospective, multicenter study.
  
  
  METHODS
  Two university hospitals and one central hospital.
  
  
  METHODS
  A consecutive series of 859 patients who underwent elective coronary artery bypass grafting from January 2008 through December 2010.
  
  
  METHODS
  Aspirin (100 mg/day) was used <3 days before surgery in 240 patients and was discontinued >3 days before surgery in 619 patients.
  
  
  RESULTS
  In the overall series, similar in-hospital mortality, amount of postoperative blood loss, rate of re-exploration for excessive bleeding, and use of blood products were observed in the study groups. However, aspirin discontinuation >3 days before surgery tended to be associated with a higher postoperative stroke rate (1.9% v 0.4%, p = 0.13). Such a trend was observed after off-pump (1.9% v 0%, p = 0.58) and on-pump (2.0% v 0.6%, p = 0.46) surgery. Among 153 pairs matched by the propensity score, patients with aspirin discontinued >3 days before surgery had a significantly higher rate of postoperative stroke (5.9% v 0.7%, p = 0.02) and tended to have a higher risk of the composite adverse outcome endpoint (19.6% v 12.4%, p = 0.09). The postoperative release of troponin I was similar in the study groups.
  
  
  CONCLUSIONS
  Late or no discontinuation of low-dose aspirin before coronary artery bypass grafting may decrease the risk of postoperative stroke without increased postoperative bleeding and need for blood transfusion. These findings and the risk of cardiovascular events possibly occurring at the time of its discontinuation suggest that the use of aspirin until the day of elective coronary surgery may be beneficial.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Reija
authors.initials: R
authors.lastname: Mikkola
authors.forename: Jan-Ola
authors.initials: JO
authors.lastname: Wistbacka
authors.forename: Jarmo
authors.initials: J
authors.lastname: Gunn
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.forename: Jarmo
authors.initials: J
authors.lastname: Lahtinen
authors.forename: Kari
authors.initials: K
authors.lastname: Teittinen
authors.forename: Kari
authors.initials: K
authors.lastname: Kuttila
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001241:Aspirin