Clinical outcomes associated with per-operative discontinuation of aspirin in patients with coronary artery disease: A systematic review and meta-analysis.
BACKGROUND
Postoperative state is characterized by increased thrombotic risk by virtue of platelet activation. Whether aspirin ameliorates this risk in patients with established coronary artery disease undergoing cardiac or noncardiac surgery is unknown. We conducted a systematic review and meta-analysis to compare the risk of major adverse cardiac events (MACE) and the risk of bleeding in patients with early (3-5 or more days before surgery) vs. late discontinuation(<3-5 days)/no discontinuation of aspirin.


METHODS
Multiple databases were searched from inception of these databases until March 2015 to identify studies that reported discontinuation of aspirin in patients undergoing surgery. The outcomes measured were all cause mortality, nonfatal myocardial infarction and other relevant thrombotic events (MACE) which also may include, fatal and nonfatal MI, stent thrombosis and restenosis, stroke, perioperative cardiovascular complications (heart failure, MI, VTE, acute stroke) and perioperative bleeding during the perioperative period to up to 30 days after surgery.


RESULTS
A total of 1,018 titles were screened, after which six observational studies met the inclusion criteria. Our analysis suggests that there is no difference in MACE with planned discontinuation of aspirin (OR = 1.17, 95% CI = 0.76-1.81; P = 0.05; I2= 55%). Early discontinuation of aspirin showed a decreased risk of peri-operative bleeding (OR 0.82, 95% CI = 0.67-0.99; P = 0.04; I2= 42%).


CONCLUSIONS
Our analysis suggests that planned short-term discontinuation in the appropriate clinical setting appears to be safe in the correct clinical setting with no increased risk of thrombotic events and with a decreased risk of bleeding. © 2016 Wiley Periodicals, Inc.
Mercy Saint Vincent Medical Center, Toledo, Ohio.
Faraz Khan
FK
Luni
Cleveland Clinic, Cleveland, Ohio.
Haris
H
Riaz
University of Louisville, Louisville, Kentucky.
Abdur Rahman
AR
Khan
Bronx Lebanon Hospital, New York, New York.
Talha
T
Riaz
University of Arizona, Tucson, Arizona.
Muhammad
M
Husnain
University of Arizona, Tucson, Arizona.
Irbaz Bin
IB
Riaz
Dow University of Health Sciences, Karachi, Pakistan.
Muhammad Shahzeb
MS
Khan
Mercy Saint Vincent Medical Center, Toledo, Ohio.
Mohammed
M
Taleb
Mercy Saint Vincent Medical Center, Toledo, Ohio.
Yusuf
Y
Kanjwal
University of Toledo Medical Center, Toledo, Ohio.
Christopher J
CJ
Cooper
University of Toledo Medical Center, Toledo, Ohio.
Sadik A
SA
Khuder
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D003328:Coronary Thrombosis / Q000209:etiology; D004334:Drug Administration Schedule; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D064887:Observational Studies as Topic; D016017:Odds Ratio; D019990:Perioperative Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D001241:Aspirin
ACS; MACE; antiplatelet; aspirin discontinuation; bleeding; secondary prevention; surgery; thrombosis