Effects of preoperative aspirin in coronary artery bypass grafting: A double-blind, placebo-controlled, randomized trial

The Journal of Thoracic and Cardiovascular Surgery, 05/08/2012

Performing coronary grafts on aspirin is associated with increased postoperative bleeding but may decrease the long–term hazard of coronary events.

Methods

  • This randomized, double–blind, parallel–group, single–center trial involved patients with stable coronary artery disease who were assigned to receive either 300 mg of aspirin or placebo the night before coronary bypass surgery.
  • Using a random digit table, patients were allocated to receive the tablet from 1 of the 40 coded bottles containing either aspirin or placebo.
  • Patients, surgeons, anesthetists, and investigators were all masked to treatment allocation.
  • The primary safety end points were as follows: more than 750 mL of bleeding during the first postoperative 12 hours and more than 1000 mL of total discharge from the chest drains.
  • The secondary efficacy end point was a composite of cardiovascular death, myocardial infarction, or repeat revascularization.

Results

  • A total of 390 patients were allocated to aspirin (387 analyzed) and 399 to placebo (396 analyzed).
  • The follow–up median was 53 months.
  • Fifty–four placebo recipients and 86 aspirin recipients bled more than 750 mL in the first 12 hours (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25–2.63), while total chest drain discharge was above 1000 mL in 96 placebo and 131 aspirin recipients (OR, 1.60; 95% CI, 1.17–2.18).
  • Preoperative aspirin decreased the long–term hazard of nonfatal coronary event (infarction or repeat revascularization)–hazard ratio (HR), 0.58 (95% CI, 0.33–0.99)–and tended to decrease the hazard of a major cardiac event (cardiovascular death, infarction, or repeat revascularization–HR, 0.65 [95% CI, 0.41–1.03]).

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