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Safety of coronary bypass surgery during ongoing aspirin treatment

Altarev S. S., Krivoshapova K. E., Malyshenko E. S., Plotnikov G. P., Ivanov S. V., Barbarash O. L.
Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: aspirin, coronary heart disease, coronary bypass surgery, surgical therapy

DOI: 10.18087/rhj.2014.5.1977

Background. Current guidelines recommend no need to discontinue aspirin before most elective surgeries. Nevertheless, the tactics of perioperative aspirin treatment varies at different medical institutions. A common practice is discontinuing aspirin before an elective surgery on the heart and large blood vessels for concerns about the increased risk of bleeding. Aim. To evaluate safety of coronary bypass (CB) surgery without preoperative aspiring withdrawal. Materials and methods. We analyzed data of patients who have had CB without preoperative aspirin withdrawal (aspirin treatment group) for the period from August through December, 2013 (103 patients). Reference group consisted of 223 patients who have had CB surgery after a standard preoperative preparation (standard treatment group). This standard preparation implied discontinuation of aspirin at least 5 days prior to the planned intervention and subcutaneous administration of direct anticoagulants (unfractionated or low molecular weight heparins) or the complete absence of antithrombotic therapy in the preoperative period (by judgment of doctor in charge). Results. Matching by propensity scores provided 74 pairs of patients. The study groups were comparable by most of clinical and medial history characteristics. Intra-operative loss of blood was comparable in the study groups (p=0.62); however drainage volumes were significantly larger in the aspirin treatment group during the first 6 and 12 hours postsurgery (mean difference, 35.3 ml; 95 % CI, 6.7 to 63.9 ml; p=0.001 and 66.2 ml; 95 % CI, 19.7 to 112.7 ml; p<0.001, respectively). Nevertheless, the total loss of blood for 24 h postsurgery was not significantly different between the study groups (mean difference, 63.9 ml; 95 % CI, – 0.7 to 128.5 ml; p=0.13). Cerebo- and cardiovascular events were not observed in any of the groups during the early postoperative period of CB. Incidence of resternotomy for bleeding was comparable in both groups. Conclusion. The results of study support the comparable safety of CB surgery with ongoing aspirin treatment or aspirin withdrawal at least 5 days prior to the surgery.
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Altarev S. S., Krivoshapova K. E., Malyshenko E. S. et al. Safety of coronary bypass surgery during ongoing aspirin treatment. Russian Heart Journal. 2014;79 (5):278–286

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