Department of Surgery, Oulu University Hospital, Oulu, Finland.
J Cardiothorac Vasc Anesth. 2012 Apr;26(2):245-50. doi: 10.1053/j.jvca.2011.09.024. Epub 2011 Dec 3.
Whether aspirin should be discontinued before coronary artery bypass grafting is controversial. The potential benefits and harms associated with late use of aspirin (no discontinuation or discontinuation <3 days before surgery) were investigated in this retrospective, multicenter study.
Retrospective, multicenter study.
Two university hospitals and one central hospital.
A consecutive series of 859 patients who underwent elective coronary artery bypass grafting from January 2008 through December 2010.
Aspirin (100 mg/day) was used <3 days before surgery in 240 patients and was discontinued >3 days before surgery in 619 patients.
In the overall series, similar in-hospital mortality, amount of postoperative blood loss, rate of re-exploration for excessive bleeding, and use of blood products were observed in the study groups. However, aspirin discontinuation >3 days before surgery tended to be associated with a higher postoperative stroke rate (1.9% v 0.4%, p = 0.13). Such a trend was observed after off-pump (1.9% v 0%, p = 0.58) and on-pump (2.0% v 0.6%, p = 0.46) surgery. Among 153 pairs matched by the propensity score, patients with aspirin discontinued >3 days before surgery had a significantly higher rate of postoperative stroke (5.9% v 0.7%, p = 0.02) and tended to have a higher risk of the composite adverse outcome endpoint (19.6% v 12.4%, p = 0.09). The postoperative release of troponin I was similar in the study groups.
Late or no discontinuation of low-dose aspirin before coronary artery bypass grafting may decrease the risk of postoperative stroke without increased postoperative bleeding and need for blood transfusion. These findings and the risk of cardiovascular events possibly occurring at the time of its discontinuation suggest that the use of aspirin until the day of elective coronary surgery may be beneficial.
在冠状动脉旁路移植术（CABG）之前是否应停用阿司匹林仍存在争议。本回顾性多中心研究旨在调查晚期使用阿司匹林（不停用或术前 3 天内停药）的潜在益处和危害。
回顾性多中心研究。
两所大学医院和一家中心医院。
2008 年 1 月至 2010 年 12 月期间行择期 CABG 的连续 859 例患者。
240 例患者在术前 3 天内使用（每天 100mg）阿司匹林，619 例患者术前 3 天以上停用阿司匹林。
在整个系列中，研究组之间的住院死亡率、术后出血量、因过度出血再次探查的比率和血制品的使用情况相似。然而，阿司匹林停药>3 天与术后卒中发生率较高相关（1.9%比 0.4%，p=0.13）。这一趋势在非体外循环（1.9%比 0%，p=0.58）和体外循环（2.0%比 0.6%，p=0.46）手术中均可见。在通过倾向评分匹配的 153 对患者中，阿司匹林停药>3 天的患者术后卒中发生率显著较高（5.9%比 0.7%，p=0.02），且复合不良结局终点的风险较高（19.6%比 12.4%，p=0.09）。研究组之间的肌钙蛋白 I 术后释放情况相似。
在 CABG 术前晚期或不停用低剂量阿司匹林可能降低术后卒中风险，而不会增加术后出血和输血需求。这些发现以及停药时可能发生的心血管事件风险提示，在择期冠状动脉手术当天继续使用阿司匹林可能是有益的。
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