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Circulation, Vol 84, 520-526, Copyright © 1991 by American Heart Association
S Goldman, J Copeland, T Moritz, W Henderson, K Zadina, T Ovitt, KB Kern, G Sethi, GV Sharma and S Khuri
BACKGROUND. Although aspirin therapy started before operation improves vein
graft patency after coronary artery bypass grafting, it also causes
bleeding. The objective of this prospective, centrally directed,
randomized, double-blind, placebo-controlled trial was to compare the
effects of aspirin therapy started before operation with aspirin started 6
hours after operation on early (7-10-day) graft patency. METHODS AND
RESULTS. Patients were randomized to receive either aspirin 325 mg or
placebo the night before surgery; after operation, all patients received
aspirin 325 mg daily, with the first dose administered through the
nasogastric tube 6 hours after operation. Angiography was performed in 72%
of the analyzed patients an average of 8 days after operation, and the
primary end point was saphenous vein graft patency in 351 patients.
Internal mammary artery graft patency was also assessed in 246 patients
because many individuals received both internal mammary artery and vein
grafts. In the patients given preoperative aspirin, the vein graft
occlusion rate was 7.4 +/- 1.3% compared with 7.8 +/- 1.5% in those who
received preoperative placebo (p = 0.871). In the subgroup of patients
receiving Y grafts, 0.0% of the grafts were occluded in the preoperative
aspirin group compared with 7.0 +/- 3.6% in the preoperative placebo group
(p = 0.066). The internal mammary artery occlusion rate was 0.0% (0 of 131)
in the aspirin group compared with 2.4 +/- 1.4% (three of 125) in the
placebo group (p = 0.081). Patients in the aspirin group received more
transfusions than those in the placebo group (median, 900 versus 725 ml, p
= 0.006). The reoperation rate for bleeding in the aspirin group was 6.3%
compared with 2.4% in the placebo group (p = 0.036). Median chest tube
drainage within the first 6 hours after operation was 500 ml in the aspirin
group compared with 448 ml in the placebo group (p = 0.011). CONCLUSIONS.
Thus, preoperative aspirin is associated with increased bleeding
complications and offers no additional benefit in early vein graft patency
compared with starting aspirin therapy 6 hours after operation. There was a
trend, although not significant, toward improved early patency for Y grafts
and internal mammary artery grafts with preoperative aspirin.
ARTICLES
Starting aspirin therapy after operation. Effects on early graft patency. Department of Veterans Affairs Cooperative Study Group
Department of Veterans Affairs Medical Center, Tucson, AZ 85723.
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