Stamenovic Davor, Schneider Thomas, Messerschmidt Antje
Department of Thoracic Surgery, ViDia Kliniken, Karlsruhe, Germany.
Interact Cardiovasc Thorac Surg. 2019 Apr 1;28(4):535-541. doi: 10.1093/icvts/ivy255.
Acetylsalicylic acid (ASA, aspirin) is a medication widely used for primary and secondary prevention of cardiovascular diseases, which are the leading cause of morbidity and mortality worldwide. Whether aspirin should be continued or paused in the perioperative period remains controversial, especially in thoracic surgical settings.
A single-centred retrospective study comprised 486 patients. Of these, 329 patients did not use aspirin (group ASA-0) and 157 did (group ASA-1) during the perioperative period after anatomical lung resection at our hospital from January 2013 to December 2016. Major outcome measures were the amount of blood loss during the operation and during the first 5 days postoperatively (per Mercuriali's formula), as well as the amount and proportion of the blood transfusion (packed red cells) received. The need for reoperation due to a postoperative haemothorax and/or bleeding was recorded. The groups were also compared according to their rates of morbidity and mortality. Inferential statistical methods with bootstrap analysis using 1000 samples and the Mersenne Twister, a random number generator, were used.
There were no significant differences between the 2 groups in intraoperative bleeding [ASA-0M = 418.69 ml, standard deviation (SD) ± 364.87; ASA-1M = 399.8 ml, SD ± 323.84; P = 0.58] or in total blood loss according to Mercuriali's formula (ASA-0M = 1111.62 ml, SD ± 816.69; ASA-1M = 1115.08 ml, SD ± 682.12; P = 0.95). A total of 104 patients received transfusions up to postoperative day 5: 71 patients in the ASA-0 group received 151 blood transfusions, whereas 33 patients in the ASA-1 group received 65 blood transfusions (P = 0.66). The indication for reoperation due to bleeding (ASA-1 = 3, ASA-0 = 4; P = 0.69) was similar between the groups. There was a trend towards higher rates of postoperative complications in the ASA-1 group (risk ratio (RR) = 1.28; P = 0.055); neither cardiovascular complications nor deaths were more frequent in either of the 2 groups (P = 0.73).
Patients taking aspirin therapy and undergoing anatomical lung resection seem not to be at any disadvantage regarding bleeding. However, a trend towards a higher rate of postoperative complications indicates a basically increased risk for operations due to comorbidities in these patients.
乙酰水杨酸（ASA，阿司匹林）是一种广泛用于心血管疾病一级和二级预防的药物，而心血管疾病是全球发病和死亡的主要原因。围手术期阿司匹林是应继续使用还是停用仍存在争议，尤其是在胸外科手术中。
一项单中心回顾性研究纳入了486例患者。其中，2013年1月至2016年12月在我院接受解剖性肺切除术后围手术期，329例患者未使用阿司匹林（ASA-0组），157例患者使用了阿司匹林（ASA-1组）。主要观察指标包括手术期间及术后前5天的失血量（根据Mercuriali公式计算），以及输注的血液量和比例（浓缩红细胞）。记录因术后血胸和/或出血而需要再次手术的情况。还根据两组的发病率和死亡率进行了比较。采用具有1000个样本的自举分析和随机数生成器梅森旋转算法的推断统计方法。
两组在术中出血方面无显著差异[ASA-0组中位数（M）=418.69ml，标准差（SD）±364.87；ASA-1组M=399.8ml，SD±323.84；P=0.58]，根据Mercuriali公式计算的总失血量也无显著差异（ASA-0组M=1111.62ml，SD±816.69；ASA-1组M=1115.08ml，SD±682.12；P=0.95）。共有104例患者在术后第5天接受了输血：ASA-0组71例患者接受了151次输血，而ASA-1组33例患者接受了65次输血（P=0.66）。两组因出血而再次手术的指征相似（ASA-1组=3例，ASA-0组=4例；P=0.69）。ASA-1组术后并发症发生率有升高趋势（风险比（RR）=1.28；P=0.055）；两组的心血管并发症和死亡发生率均无差异（P=0.73）。
接受阿司匹林治疗并接受解剖性肺切除的患者在出血方面似乎没有任何劣势。然而，术后并发症发生率升高的趋势表明，这些患者因合并症而手术的风险基本增加。
