Taking Aspirin Prior to Cardiac Surgery Aids Recovery, Prevents Complications, Early Death
This outcome could lead to new preoperative treatment standards in cardiac medicine
Dec. 5,
2011 Taking aspirin within five days of cardiac surgery seems to be responsible for a significant decrease in the risk of major
postoperative complications, including renal failure, a lengthy intensive care unit stay and even early death, according to a study by
researchers at Thomas Jefferson University and UC Davis Medical Center to appear in the journal Annals of Surgery.
The findings are significant, the authors say, because despite remarkable progress in cardiac surgery, the number of
major complications from cardiac surgery remains high.
...important because increasing numbers of older adults are living with cardiovascular disease, and in clinical practice
many patients are not getting indicated therapies
"Therapies targeted to prevent or reduce major complications associated with cardiac surgery have been few and
ineffective so far," said 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 (total 4,256 consecutive
patients) who had cardiac surgery - mostly coronary artery bypass graft or valve surgery - at Thomas Jefferson University Hospital or UC Davis
Medical Center between 2001 and 2009.
Among 2,868 patients who met the inclusion criteria, 1,923 took aspirin (about 81 to 325 mg daily) at least once within
five days preceding their surgery versus 945 not taking aspirin (non-aspirin therapy).
The outcomes showed that preoperative aspirin therapy - vs. non-aspirin - is associated with a significant decrease in
the risk for 30-day mortality, major adverse cardiocerebral events, postoperative renal failure and 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," said 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."
The researchers acknowledge that bleeding remains a concern with preoperative aspirin therapy. However, they said, in the
current era of cardiac surgery, the potential for bleeding may be avoided by using antifibrinolytic therapy, which prevents the breakdown of
clotting factors in the blood, and/or a low dose of aspirin.
"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 and colleagues wrote.
Added Zvi Grunwald, chair of anesthesiology at Jefferson, "While we are excited that the study clearly showed that
preoperative use of aspirin significantly reduced major complications and mortality in patients undergoing cardiac surgery, we do urge further
study before recommending aspirin for cardiac surgery patients prior to surgery."
In addition to Sun and Young, study investigators included senior author Longhui Cao, Scott Silvestry, Will Sun and James
Diehl of Thomas Jefferson University; Hong Lui of UC Davis; and Ning Zhao of the University of Pennsylvania Health System.
Dec. 5,
2011 Taking aspirin within five days of cardiac surgery seems to be responsible for a significant decrease in the risk of major
postoperative complications, including renal failure, a lengthy intensive care unit stay and even early death, according to a study by
researchers at Thomas Jefferson University and UC Davis Medical Center to appear in the journal Annals of Surgery. 