Abstract 4354: The Effect of Preoperative Aspirin on Morbidity and Mortality in Coronary Artery Bypass Surgery
Background: Aspirin has been shown to reduce postoperative CABG mortality and ischemic events. However, there has been controversy regarding timing of aspirin (ASA) discontinuation prior to CABG surgery due to concern for postoperative bleeding complications. We evaluated the effect of time of ASA discontinuation prior to CABG on postoperative bleeding and major adverse cardiovascular outcomes using the Cleveland Clinic Foundation (CCF) Cardiovascular Information Registry database.
Results: There were 4150 patients who underwent CABG surgery at the Cleveland Clinic from January 1, 2002 to January 31, 2008 who were on preoperative ASA. Of these, 2304 discontinued ASA use prior to 5 days to surgery (early discontinuation), and 1846 were taking ASA within 5 days of the surgery (late use). Early discontinuation was associated with more prior cardiac surgery, higher preoperative creatinine, and higher preoperative hematocrit. Using propensity analysis, patients were matched and outcomes of matched groups were compared. There was no significant difference between those with early discontinuation and late ASA use with regards to the composite outcome of 30-day mortality, nonfatal myocardial infarction (MI), and nonfatal stroke, 1.9% vs. 2.0% (p=0.8). There was no clinically significant difference in use of red blood cell (RBC) transfusions, see Table 1⇓. There was no difference between groups in the incidence of re-exploration for bleeding, postoperative stroke, postoperative MI, hospital length of stay, in-hospital death, or death within 30 days.
Conclusions: Among patients undergoing isolated CABG there was no difference in outcomes with regards to timing of ASA discontinuation; there were more intra-operative RBC transfusions in the late ASA group and more postoperative transfusions in the early discontinuation group. Use of ASA within 5 days of CABG appears to be safe.