title: Effect of timing of chronic preoperative aspirin discontinuation on morbidity and mortality in patients having combined coronary artery bypass grafting and valve surgery.
abstract: The objective of this study was to determine if late use of aspirin before coronary artery bypass grafting (CABG) with valve surgery affects bleeding events and major adverse cardiovascular events. Aspirin has been shown to decrease postoperative CABG mortality and ischemic events. There are no data on the time of aspirin discontinuation and its effect on CABG with valve surgery and bleeding complications. From January 1, 2002 to January 31, 2008, 1,963 patients undergoing nonurgent plus valve surgery at the Cleveland Clinic were on preoperative aspirin; 1,404 (72%) discontinued aspirin ≥ 6 days before surgery (early discontinuation) and 559 (28%) continued aspirin within 5 days of surgery (late use). Propensity-score analysis and matching were employed for fair comparison of outcomes. There was no difference between early-discontinuation and late-use groups in the composite outcome of in-hospital mortality, myocardial infarction, and stroke (5.3% in the 2 groups). More patients in the late-use group received postoperative transfusions (49% vs 42%, p = 0.02). There was a trend toward increased reoperation for bleeding (6.1% vs 3.7%, p = 0.08) in the late-use group. In conclusion, in patients undergoing CABG with valve surgery, there was an increased use of postoperative red blood cell transfusion and a trend toward increased reoperation for bleeding in the late-use group. There was no difference in major adverse cardiac events between groups. Late use of aspirin in CABG with valve surgery must be weighed against an increased risk of bleeding.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Jacob
authors.forename: Nicholas
authors.initials: N
authors.lastname: Smedira
authors.forename: Eugene
authors.initials: E
authors.lastname: Blackstone
authors.forename: Sarah
authors.initials: S
authors.lastname: Williams
authors.forename: Leslie
authors.initials: L
authors.lastname: Cho
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000401:mortality*; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D009820:Ohio / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D005343:Fibrinolytic Agents; D001241:Aspirin