Preoperative Aspirin Use and Its Effect on Adverse Events in Patients Undergoing Cardiac Operations.
BACKGROUND
Preoperative aspirin use within 5 days of cardiac operations is controversial. Aspirin could reduce cardiovascular complications and yet might increase risk of bleeding. Recent reports showed conflicting results, and whether aspirin has variable effects for different cardiac surgical procedures is unclear.


METHODS
A single-center retrospective cohort analysis was performed. After propensity score matching (PSM) for identified confounders, the relationship between preoperative aspirin use and 30-day all-cause mortality, postoperative renal failure, major adverse cardiocerebral events (MACE), blood transfusion, reoperation for bleeding, and postoperative infection were estimated with separate logistic regression models.


RESULTS
Preoperative aspirin therapy was associated with a 49% (p = 0.04) increased risk of reoperation for bleeding among 868 matched pairs of patients undergoing valve operations. Among 725 matched patients undergoing coronary artery bypass grafting (CABG), preoperative aspirin therapy was not associated with a statistically significant higher risk of reoperation for bleeding. However, preoperative aspirin use, compared with nonuse, was not associated with risks of MACE, 30-day mortality, postoperative renal failure, blood transfusion, or postoperative infection in the entire cohort, in patients undergoing valve operations only, and in patients undergoing CABG only after PSM.


CONCLUSIONS
Preoperative aspirin use in all patients undergoing cardiac operations was not associated with risks of major cardiac, cerebral, or renal complications and infections and death; however, the risk of reoperation for bleeding was elevated among preoperative aspirin users compared with nonusers in a subpopulation of patients undergoing valve operations only.
Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky; Department of Anesthesiology, Jewish Hospital, Louisville, Kentucky. Electronic address: jiapenghuang@yahoo.com.
Jiapeng
J
Huang
Department of Epidemiology and Population Health, University of Louisville, Louisville, Kentucky; Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts.
Macarius
M
Donneyong
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Jaimin
J
Trivedi
Department of Anesthesiology, Jewish Hospital, Louisville, Kentucky.
April
A
Barnard
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
John
J
Chaney
KentuckyOne Health, Louisville, Kentucky.
Adam
A
Dotson
KentuckyOne Health, Louisville, Kentucky.
Sherri
S
Raymer
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Allen
A
Cheng
Department of Anesthesiology and Pain Medicine, University of California, Davis, Davis, California.
Hong
H
Liu
Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky.
Mark S
MS
Slaughter
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000139:chemically induced / Q000453:epidemiology* / Q000628:therapy; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin