Aspirin deemed safe to use before coronary artery surgery

By John Murphy, MDLinx
Published February 24, 2016

Key Takeaways

Patients undergoing coronary artery surgery don’t need to discontinue aspirin, according to results of a 10-year international trial published February 24, 2016 in the New England Journal of Medicine.

Patients who took aspirin right up to the day of coronary artery surgery had no greater risk of death or thrombotic complications, nor a higher risk of surgical bleeding, need for transfusion, or need for reoperation than similar patients on placebo, this study found.

“The message is now simple—for coronary artery surgery, stay on the aspirin,” said the study’s lead author Paul S. Myles, MPH, MD, Director of Anesthesia and Perioperative Medicine at The Alfred Hospital and Monash University, in Melbourne, Australia.

Most patients with coronary artery disease take daily aspirin to prevent heart attack, stroke, and death. However, there is no consensus on what a patient undergoing coronary artery surgery should do. “Some patients are kept on aspirin right up until surgery, while others are stopped on medical advice due to concern it may increase the risk of surgical bleeding,” Dr. Myles said.

But the increased risk of bleeding during surgery could be outweighed by aspirin’s beneficial effect on coronary-graft flow and reduction in the risk of blood clots, heart attack, and possibly stroke, the researchers noted.

“Faced with conflicting guidelines from expert professional organizations, we needed evidence to determine if the perceived increased risk of surgical bleeding could be outweighed by a beneficial effect of aspirin,” Dr. Myles explained.

For this trial, Dr. Myles and his fellow researchers enrolled 2,100 patients from 21 hospitals on four continents. The researchers randomized half the patients to receive aspirin and half to receive placebo at 1 to 2 hours before surgery.

Within 1 month after surgery, death and thrombotic complications occurred at comparable rates in both groups—19% (202 patients) in the aspirin group and 20% (215) patients in the placebo group. Of these, heart attack occurred in 14% (144 patients) on aspirin and in 16% (166 patients) on placebo.

Additionally, “Our study showed no increased risk of surgical bleeding or need for blood transfusion, so we now have clear evidence that aspirin can be safely continued up to the day of coronary artery surgery,” Dr. Myles said.

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