Late aspirin cessation does not worsen CABG outcomes
MedWire News: Late discontinuation of aspirin is not associated with an increased risk for adverse cardiovascular (CV) outcomes in patients undergoing coronary artery bypass graft (CABG) surgery, study results suggest.
But patients who use aspirin within 5 days before CABG (late discontinuation) are more likely to require an intra- or postoperative blood transfusion than those who stop taking aspirin at least 6 days before surgery (early discontinuation).
"Thus, we recommend weighing the risks and benefits of late aspirin use in these patients," say Leslie Cho (Cleveland Clinic, Ohio, USA) and co-authors.
In the study, Cho and team assessed the outcomes of1845 late and 2298 early aspirin-discontinuation patients who were matched into 1519 patient-pairs using propensity score analysis.
As reported in the journal Circulation, the rate of the combined outcome of myocardial infarction, stroke, and inpatient death did not differ significantly between the late and early discontinuation groups, at 1.8% and 1.7%, respectively.
Intra- and postoperative blood transfusions, however, were more frequent among the late than early discontinuation patients, at 23% versus 20% (p=0.03) and 30% versus 26% (p=0.009), respectively.
Despite the differing blood transfusion rates between groups, Cho et al note that reoperations for bleeding occurred at a similar rate of 3.4% and 2.4% among the late and early discontinuation patients, respectively.
In a related commentary, Paul Myles (Alfred Hospital, Melbourne, Victoria, Australia) highlighted that the study by Cho et al raises the question of "whether or not we should be stopping aspirin therapy at all, and whether or not antifibrinolytic therapy can help prevent any bleeding complications of aspirin while at the same time continuing its antithrombotic benefit."
He concluded that the currently ongoing ATACAS (Aspirin and Tranexamic Acid for Coronary Artery Surgery) trial may provide answers to this question on its completion.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Lauretta Ihonor