Abstract 12118: Risk of Thrombotic Events After Discontinuation of Aspirin in Perioperative Period in Patients With Established or at Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis
Introduction: Aspirin for prolonged duration is commonly prescribed to patients with a history of cardiovascular events who are at continued risk for occlusive vascular events (secondary prevention). Patients in the peri-operative period are not only at an increased risk of bleeding but also for thrombotic vascular events because of the pro-thrombotic milieu.
Hypothesis: The objective of our study was to do a systematic review and meta-analysis to compare the risk of thrombotic events and the risk of bleeding in patients with early (3-5 days) versus late discontinuation/no discontinuation of aspirin.
Methods: PubMed and Embase were searched to identify the studies that report discontinuation or non-adherence of aspirin in patients undergoing surgery. The studies were included if they reported thrombotic events (stroke, all-cause mortality, MI, stent thrombosis & restenosis, stroke, heart failure, VTE, acute limb ischemia, perioperative cardiovascular complications) and perioperative bleeding. Odds ratio was calculated for the measured outcomes. The outcomes were pooled by generic inverse variance method in a random effects model and corresponding forest plots were made. Quality assessment was done as per Newcastle-Ottawa scale.
Results: Our search strategy revealed 1018 studies out of which 6 observational studies (3 evaluating cardiac and 3 non-cardiac surgeries) met the inclusion criteria. There was no difference in the risk of thrombotic events both in early or late discontinuation of aspirin (OR 1.17, 95% CI= 0.74-1.84, p =0.50; I2 = 56%) (Figure 1). 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%) (Figure 2).
Conclusion: Planned discontinuation of aspirin is acceptable with no increased risk of thrombotic events and with a decreased risk of bleeding. Moreover the decreased risk of peri-operative complications may help reduce the length of stay and associated co-morbidities.
Author Disclosures: F. Luni: None. H. Riaz: None. A.R. Khan: None. S. Khuder: None. Y. Kanjwal: None.
- © 2015 by American Heart Association, Inc.