Ma Xiaochun, Ma Chi, Yun Yan, Zhang Qian, Zheng Xia
1Shandong University School of Medicine, Jinan, Shandong, China.
J Cardiovasc Pharmacol Ther. 2014 Jan;19(1):97-113. doi: 10.1177/1074248413509026. Epub 2013 Nov 7.
The administration of aspirin is traditionally discontinued prior to coronary artery bypass grafting (CABG), given a potential risk of excessive postoperative bleeding. Few studies have previously suggested the benefits of continuing aspirin until the time of surgery. The primary aim of this review is to evaluate the effects of preoperative aspirin therapy on several clinically important outcomes in patients undergoing CABG.
A meta-analysis of eligible studies of patients undergoing CABG, reporting preoperative aspirin in comparison with no aspirin/placebo and our outcomes, was carried out. The safety outcomes included postoperative bleeding, packed red blood cell (PRBC) transfusion requirements, and reoperation for bleeding. The efficacy outcomes included perioperative myocardial infarction (MI), cerebrovascular accidents (CVAs), and mortality.
In 8 randomized controlled trials (RCTs; n = 1538), preoperative aspirin increased postoperative bleeding (difference in means = 132.30 mL; 95 % confidence interval [CI] 47.10-217.51; P = .002), PRBC transfusion requirements (difference in means = 0.67 units; 95% CI 0.10-1.24; P = .02), and reoperation for bleeding (odds ratio [OR] = 1.76; 95% CI 1.05-2.93; P = .03). In 19 observational studies (n = 19551), preoperative aspirin increased postoperative bleeding (difference in means = 132.74 mL; 95% CI 45.77-219.72; P = .003) and PRBC transfusion requirements (difference in means = 0.19 units; 95% CI 0.02-0.35; P = .02) but not reoperation for bleeding (OR = 1.13; 95% CI 0.91-1.42; P = .27). Subgroup analyses for RCTs demonstrated that aspirin given at doses ≤ 100 mg/d might not increase the postoperative bleeding, and the dose of 325 mg/d might not be a cutoff value that has clinical and statistical significance. No statistically significant differences in the rate of perioperative MI, CVAs, or mortality were seen between the 2 groups.
Preoperative aspirin therapy is associated with increased postoperative bleeding, PRBC transfusion requirements, and reoperation for bleeding in patients undergoing CABG. Doses lower than 100 mg/d may minimize the risk of bleeding. Additional RCTs are needed to assess the effects of preoperative aspirin on the safety and efficacy outcomes in patients undergoing CABG.
鉴于术后出血过多的潜在风险，传统上在冠状动脉旁路移植术（CABG）前会停用阿司匹林。此前很少有研究表明持续使用阿司匹林直至手术时的益处。本综述的主要目的是评估术前阿司匹林治疗对接受CABG患者的几个临床重要结局的影响。
对符合条件的接受CABG患者的研究进行荟萃分析，报告术前使用阿司匹林与不使用阿司匹林/安慰剂相比的情况及我们的结局。安全性结局包括术后出血、浓缩红细胞（PRBC）输注需求以及因出血而再次手术。疗效结局包括围手术期心肌梗死（MI）、脑血管意外（CVA）和死亡率。
在8项随机对照试验（RCT；n = 1538）中，术前使用阿司匹林增加了术后出血（均值差异 = 132.30 mL；95%置信区间[CI] 47.10 - 217.51；P = 0.002）、PRBC输注需求（均值差异 = 0.67单位；95% CI 0.10 - 1.24；P = 0.02）以及因出血而再次手术的情况（比值比[OR] = 1.76；95% CI 1.05 - 2.93；P = 0.03）。在19项观察性研究（n = 19551）中，术前使用阿司匹林增加了术后出血（均值差异 = 132.74 mL；95% CI 45.77 - 219.72；P = 0.003）和PRBC输注需求（均值差异 = 0.19单位；95% CI 0.02 - 0.35；P = 0.02），但未增加因出血而再次手术的情况（OR = 1.13；95% CI 0.91 - 1.42；P = 0.27）。RCT的亚组分析表明，剂量≤100 mg/d的阿司匹林可能不会增加术后出血，325 mg/d的剂量可能不是具有临床和统计学意义的临界值。两组之间围手术期MI、CVA或死亡率的发生率没有统计学显著差异。
术前阿司匹林治疗与接受CABG患者的术后出血增加、PRBC输注需求增加以及因出血而再次手术有关。低于100 mg/d的剂量可能会将出血风险降至最低。需要更多的RCT来评估术前阿司匹林对接受CABG患者安全性和疗效结局的影响。
