Effect Of Preoperative Aspirin Therapy On Early Postoperative Outcomes In Patients Undergoing Coronary Artery Bypass Grafting

Objective: To analyze the benefits and risks of preoperative aspirin treatment in patients undergoing off-pump coronary artery bypass grafting, and its effects on complications in elderly patients.Methods: The consecutive patients underwent selective first-time isolated off-pump coronary artery bypass surgery in Tianjin Chest Hospital from January 2010 to June 2014 were included in this study. The subjects were divided into 2 groups: 1ong term use of aspirin within 5 days before operation, and not use of aspirin within 5 days preceding surgery. Univariate analysis and a logistic regression model were used to compare the postoperative events. To adjust for the remaining differences between groups, propensity score was included into the logistic regression model. The same method was used to analyze the elderly patients.Results: 1. A total of 3531 patients were included, of which 2564 were males, and 967 were females.The average age was 63.2(±8.5) years. 817 patients sustained aspirin within 5 days before operation and 2714 patients stopped aspirin 5 days or more. There were 29 patients died in the postoperative hospitalization period. No significant differences were found between the two groups on all-cause in-hospital mortality(adjusted OR0.87, 95%CI0.35-2.26,P=0.80), perioperative myocardial infarction(adjusted OR0.52, 95%CI0.15-1.81, P=0.31),cerebrovascular events(adjusted OR1.06, 95%CI0.32-3.49, P=0.93),reoperation for bleeding(adjusted OR0.79,95%CI0.46-1.36,P=0.40), postoperative renal failure(adjusted OR0.86, 95%CI0.40-1.84, P=0.70) or blood dialysis(adjusted OR0.58,95%CI0.12-2.68, P=0.48), but the use of aspirin within 5 days preceding surgery was associated with more frequencies of RBC transfutions(adjusted OR1.39, 95%CI1.16-1.66, P<0.01).2. In elderly(>65years) patients, there were no significant differences between the two groups on all-cause in-hospital mortality(adjusted OR0.53, 95% CI0.15-1.95, P=0.34), postoperative myocardial infarction(adjusted OR0.32, 95%CI0.04-2.62,P=0.29), cerebrovascular events(adjusted OR1.30,95%CI0.24-6.91, P=0.76), reoperation for bleeding(adjusted OR0.88, 95%CI0.41-1.87, P=0.74), postoperative renal failure(adjusted OR 0.53, 95%CI0.17-1.65, P=0.27) or blood dialysis(adjusted OR0.42, 95%CI0.05-3.83, P=0.44), either. However, preoperative aspirin treatment was associated with more frequencies of red blood cell transfusions(adjusted OR1.50, 95%CI1.13-2.00, P<0.01).Conclusion: 1. Preoperative treatment of aspirin resulted in an increased RBC transfusion requirement, but didn’t increase reoperation for bleeding.2. Among patients undergoing selective isolated OPCAB, there was no difference in the early postoperative outcomes including all-cause in-hospital mortality, perioperative myocardial infarction, cerebrovascular events, reoperation, postoperative renal failure or blood dialysis.3. Among elderly patients, preoperative use of aspirin resulted in an increased RBC transfusion requirement, but also didn’t increase reoperation for bleeding.4. Among elderly patients undergoing selective isolated OPCAB, preoperative use of aspirin has no effect on the postoperative outcomes such as all-cause in-hospital mortality, postoperative myocardial infarction, cerebrovascular events, reoperation, postoperative renal failure or blood dialysis.5. The conclusions above need to be further confirmed by large-scale randomized, controlled trials.