Meneguzzi J, et al. – This study investigated the optimal timing for administration of aspirin to minimise risk of perioperative morbidity and mortality. In patients who underwent combined coronary artery bypass graft and valve procedures, pre –operative late discontinuation of aspirin caused greater rates of bleeding and transfusion requirements, whereas, earlier discontinuation resulted in no benefit in intermediate term survival.

Methods

• From a prospectively compiled database collected by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, researchers identified 8,294 patients undertaking combined CABG and valve or isolated valve procedures while discontinuing aspirin.
• Time points for cessation of antiplatelet therapy were categorised as follows: 7 days preoperatively.
• They assessed the association of adverse in-hospital events and intermediate term survival in each time category.

Results

• Findings demonstrated that discontinuing aspirin three to seven days from surgery decreased rates of perioperative MI (HR = 0.300, p = 0.027), return to theatre (HR = 0.560, p = 0.002) reduced drain output (HR = 0.757, p = 0.000) and red blood cell and platelet transfusions (HR = 0.719, p = 0.000 and HR = 0.604, p = 0.000 respectively) compared to patients continuing aspirin until < 2 days from the procedure.
• Researchers also observed that stopping aspirin < 2 days from the date of surgery increased risk of perioperative MI (HR = 5.919, p = 0.000), reoperation for bleeding (HR = 2.076, p = 0.001), returning to theatre (HR = 1.781, p = 0.000), ICC drain losses (HR = 1.337, p = 0.000) and transfusion demands for red blood cells (HR = 1.381, p = 0.000) and platelets (HR = 1.450, p = 0.000) when compared to those discontinuing aspirin >7 days from surgery.