Despite bleeding risk, aspirin may be beneficial before cardiac surgery
PHILADELPHIA — Aspirin taken within five days before cardiac surgery is associated with a significant decrease in the risk of major postoperative complications, including renal failure, an intensive care unit stay, and even early death (30-day mortality), according to findings from an observational cohort study by researchers at Thomas Jefferson University and the University of California Davis Medical Center that are set to appear in the journal Annals of Surgery.
The researchers acknowledged that bleeding remains a concern with preoperative aspirin therapy. However, they argued that in the current era of cardiac surgery, the potential for bleeding may be avoided by using a low dose of aspirin and/or giving antifibrinolytic therapy perioperatively.
“Therapies targeted to prevent or reduce major complications associated with cardiac surgery have been few and ineffective so far,” stated Jianzhong Sun, an anesthesiologist at Thomas Jefferson University and lead author of the study. “These complications are significant and costly both for the public health and the quality of patient life.”
The study team evaluated the impact of preoperative aspirin on major outcomes in adults (4,256 consecutive patients) who had cardiac surgery — mostly coronary artery bypass graft or valve surgery — at Thomas Jefferson University Hospital and UC Davis Medical Center between 2001 and 2009. Among 2,868 patients who met the inclusion criteria, 1,923 were taking aspirin (within about 81 to 325 mg daily) at least once within five days preceding their surgery versus 945 not taking aspirin (nonaspirin therapy).
The outcomes showed that preoperative aspirin therapy (versus non-aspirin) is associated with a significant decrease in the risk for 30-day mortality, and for the composite outcome of major adverse cardiocerebral events, postoperative renal failure, and the average time spent in the intensive care unit. Beneficial effects of preoperative aspirin use found in the current study “are in line with our previous findings and findings from early postoperative aspirin studies,” wrote Sun and colleagues in their paper.
“We know that aspirin can be lifesaving for patients who have experienced heart attacks,” stated Nilas Young, chief of cardiothoracic surgery at UC Davis and a study co-author. “Now we know that this simple intervention can do the same for patients who undergo certain coronary surgeries. This outcome could lead to new preoperative treatment standards in cardiac medicine.”
“Overall, the outcome benefits provided by preoperative aspirin therapy may override its possible risk of excess bleeding in patients undergoing cardiac surgery. Nonetheless, further studies are certainly needed to examine this potential side effect carefully,” Sun added.