Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting

Gulshan K. Sethi, Jack G. Copeland, Steven Goldman, Thomas Moritz, Karen Zadina, William G. Henderson

Research output: Contribution to journalArticle

182 Citations (Scopus)

Abstract

The perioperative consequences of preoperative aspirin administration were assessed in a large prospective cooperative study of 772 patients undergoing coronary artery bypass grafting. The 772 patients were randomized to receive either aspirin (325 mg once a day), aspirin (325 mg three times a day), aspirin plus dipyridamole (325 and 75 mg together three times a day) (aspirin group), sulfinpyrazone (267 mg three times a day) or placebo (nonaspirin group). The therapy, except in the aspirin group, was started 48 h before the operation. In all aspirin subgroups, one 325 mg aspirin dose was given 12 h before surgery and maintained thereafter according to the assigned regimen. Patients in the aspirin group had significantly more postoperative bleeding and received more packed blood cells and blood products than did patients in the nonaspirin group. Although total operative duration and cardiopulmonary bypass duration were not different, the interval between completion of cardiopulmonary bypass and wound closure was significantly longer (p = 0.035) in the aspirin group. Thirty-one (6.6%) of 471 patients in the aspirin group and 5 (1.7%) of 301 patients in the nonaspirin group also required reoperation for control of postoperative bleeding (p = 0.002). The site of bleeding found at reoperation was not different between the two groups. There was no difference in operative mortality rates, incidence of other bleeding complications or occurrence of other postoperative complications between the two groups. Thus, antiplatelet regimens involving preoperative initiation of aspirin therapy, which has been shown to improve graft patency, increase the risk of abnormal postoperative bleeding and the need for reoperation. These observations prompted a prospective clinical trial to compare the benefits and risks of preoperative versus early postoperative administration of aspirin. Until the results of the new trial are known, the data from the current study should be taken into consideration for risk assessment of patients undergoing coronary artery bypass grafting.

Original languageEnglish (US)
Pages (from-to)15-20
Number of pages6
JournalJournal of the American College of Cardiology
Volume15
Issue number1
DOIs
StatePublished - 1990
Externally publishedYes

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Coronary Artery Bypass
Aspirin
Hemorrhage
Reoperation
Cardiopulmonary Bypass
Sulfinpyrazone
Dipyridamole
Blood Cells
Placebos
Clinical Trials
Prospective Studies
Transplants

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. / Sethi, Gulshan K.; Copeland, Jack G.; Goldman, Steven; Moritz, Thomas; Zadina, Karen; Henderson, William G.

In: Journal of the American College of Cardiology, Vol. 15, No. 1, 1990, p. 15-20.

Research output: Contribution to journalArticle

Sethi, Gulshan K. ; Copeland, Jack G. ; Goldman, Steven ; Moritz, Thomas ; Zadina, Karen ; Henderson, William G. / Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. In: Journal of the American College of Cardiology. 1990 ; Vol. 15, No. 1. pp. 15-20.
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abstract = "The perioperative consequences of preoperative aspirin administration were assessed in a large prospective cooperative study of 772 patients undergoing coronary artery bypass grafting. The 772 patients were randomized to receive either aspirin (325 mg once a day), aspirin (325 mg three times a day), aspirin plus dipyridamole (325 and 75 mg together three times a day) (aspirin group), sulfinpyrazone (267 mg three times a day) or placebo (nonaspirin group). The therapy, except in the aspirin group, was started 48 h before the operation. In all aspirin subgroups, one 325 mg aspirin dose was given 12 h before surgery and maintained thereafter according to the assigned regimen. Patients in the aspirin group had significantly more postoperative bleeding and received more packed blood cells and blood products than did patients in the nonaspirin group. Although total operative duration and cardiopulmonary bypass duration were not different, the interval between completion of cardiopulmonary bypass and wound closure was significantly longer (p = 0.035) in the aspirin group. Thirty-one (6.6{\%}) of 471 patients in the aspirin group and 5 (1.7{\%}) of 301 patients in the nonaspirin group also required reoperation for control of postoperative bleeding (p = 0.002). The site of bleeding found at reoperation was not different between the two groups. There was no difference in operative mortality rates, incidence of other bleeding complications or occurrence of other postoperative complications between the two groups. Thus, antiplatelet regimens involving preoperative initiation of aspirin therapy, which has been shown to improve graft patency, increase the risk of abnormal postoperative bleeding and the need for reoperation. These observations prompted a prospective clinical trial to compare the benefits and risks of preoperative versus early postoperative administration of aspirin. Until the results of the new trial are known, the data from the current study should be taken into consideration for risk assessment of patients undergoing coronary artery bypass grafting.",
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