title: Continuing antiplatelet therapy before cardiac surgery with cardiopulmonary bypass: a meta-analysis on the need for reexploration and major outcomes.
abstract: OBJECTIVE
  To determine major adverse outcomes, including the risk of mediastinal reexploration, death, stroke and myocardial infarction, associated with continuing antiplatelet therapy in patients undergoing surgery with cardiopulmonary bypass.
  
  
  METHODS
  A meta-analysis of parallel randomized, controlled trials published in English.
  
  
  METHODS
  A university-based electronic search.
  
  
  METHODS
  Patients undergoing surgery with cardiopulmonary bypass (CPB).
  
  
  METHODS
  Continuing antiplatelet therapy versus stopping antiplatelet therapy before the surgery.
  
  
  RESULTS
  A search was conducted in PubMed, EMBASE, MEDLINE(R), and the Cochrane Central Register of Controlled Trials. Twelve studies were retained for analysis. Continuing antiplatelet drugs for CPB increases the rate of reexploration by a standardized mean difference (SMD) 0.22, 95% confidence interval (CI) 0.06, 0.39; I-square 0%; p value 0.01; classical fail-safe number 5. The number needed to harm (NNTH) is 87 (95% CI 390, 44). There was no statistical difference for death at 30 days and 1 year, myocardial infarction at 30 days, and stroke at 30 days. Continuing antiplatelet drugs increases blood loss, SMD 0.27 (95% CI 0.09, 0.45), I-square 73.1%; p = 0.003.
  
  
  CONCLUSIONS
  Continuing antiplatelet therapy for patients undergoing surgery with CPB is associated with a low risk for reexploration.
authors: University of Montreal, Montreal, QC, Canada. Electronic address: joanneguay@bell.net.
authors: Joanne
authors: J
authors: Guay
authors: University of Pennsylvania Health System, Philadelphia, PA.
authors: E
authors: E
authors: Andrew Ochroch
mesh_terms: D016063:Blood Loss, Surgical; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelets; blood loss; cardiac surgery; cardiopulmonary bypass; death; fresh frozen plasma; myocardial infarction; platelets; red blood cells; reexploration; stroke