title: Effect of Preoperative Aspirin Replacement With Enoxaparin in Patients Undergoing Primary Isolated On-Pump Coronary Artery Bypass Grafting.
abstract: Management of preoperative antiplatelet therapy in coronary artery bypass grafting (CABG) is variable among surgeons: guidelines collide with prejudices because replacement of aspirin with low-molecular-weight heparin is still performed because of a presumed minor bleeding risk. This study aims to analyze postoperative bleedings and complications in patients scheduled for elective primary isolated on-pump CABG, depending on preoperative aspirin treatment or its replacement with enoxaparin. In this cohort study, we propensity score matched 200 patients in whom aspirin was stopped at least 5 days before CABG and replaced with enoxaparin and 200 patients who continued aspirin therapy until the day before surgery. Postoperative bleedings and complications were monitored during hospitalization. Among patients who continued aspirin treatment, mean overall bleeding was 701.0 ± 334.6 ml, whereas in the matched enoxaparin group, it was significantly greater (882.6 ± 64.6 ml, p value <0.001); this was associated with reduced postoperative complications, lower values of postoperative C-reactive protein in aspirin takers, and a presumed protective effect for statins. After propensity score adjustment, aspirin treatment carried a protective effect against major postoperative bleeding (odds ratio 0.312, p = 0.001). In conclusion, postoperative bleeding is reduced in patients who continued aspirin, likely due to a reduction in postoperative inflammation. The practice of empirically discontinuing aspirin and replacing it with enoxaparin before CABG should be abandoned. Patients with coronary artery disease referred to CABG should continue antiplatelet medications until the surgical procedure. Those results might be extended to patients under oral anticoagulant therapy requiring CABG.
authors.affiliation: Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nenna
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Spadaccio
authors.affiliation: Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Prestipino
authors.affiliation: Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lusini
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors.forename: Fraser W
authors.initials: FW
authors.lastname: Sutherland
authors.affiliation: Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom.
authors.forename: Gwyn W
authors.initials: GW
authors.lastname: Beattie
authors.affiliation: Department of Hygiene, Public Health and Statistics, Università Campus Bio-Medico di Roma, Rome, Italy.
authors.forename: Tommasangelo
authors.initials: T
authors.lastname: Petitti
authors.affiliation: Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nappi
authors.affiliation: Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy. Electronic address: m.chello@unicampus.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chello
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D017558:Elective Surgical Procedures; D017984:Enoxaparin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin