Little Christopher, Odho Zain, Szydlo Richard, Aw Tuan-Chen, Laffan Mike, Arachchillage Deepa R J
Centre for Haematology, Department of Immunology and Inflammation Imperial College London London UK.
Department of Biochemistry, Royal Brompton & Harefield Hospitals Part of Guy's & St Thomas' NHS Foundation Trust London UK.
EJHaem. 2022 Feb 16;3(2):317-325. doi: 10.1002/jha2.400. eCollection 2022 May.
Major bleeding is linked to poorer outcomes following cardiac surgery. Current guidelines recommend continuation of aspirin prior to coronary artery by-pass graft (CABG) but the effect of continuing aspirin in patients with prior indication for aspirin, in particular during off-pump CABG (OPCABG), has not been systematically assessed. In this study, we analysed the effect of continuing aspirin prior to OPCABG and on-pump CABG with respect to bleeding and blood product usage. We compared propensity-matched cohorts of patients who continued aspirin until the day of OPCABG or CABG to controls (no antiplatelet) and to patients discontinuing aspirin 5-7 days prior. Length of hospital stay, 30-day mortality and thromboembolism rates were similar for both OPCABG and CABG. During OPCABG, aspirin-continued patients received more intraoperative red cell units compared to controls without difference in bleeding. Aspirin-continued patients received more blood products perioperatively and bled more than aspirin-discontinued patients undergoing OPCABG. The only difference during CABG was a small increase in the volume of cells salvaged among aspirin-continued patients compared to controls. Current guidelines on the continuation of aspirin prior to CABG and OPCABG are safe. Continuation of aspirin prior to OPCABG may result in more bleeding and blood product usage.
心脏手术后大出血与较差的预后相关。当前指南建议在冠状动脉旁路移植术(CABG)前继续使用阿司匹林,但对于有阿司匹林使用指征的患者,尤其是在非体外循环冠状动脉旁路移植术(OPCABG)期间继续使用阿司匹林的效果尚未进行系统评估。在本研究中,我们分析了在OPCABG和体外循环冠状动脉旁路移植术(on-pump CABG)前继续使用阿司匹林对出血和血液制品使用的影响。我们将持续使用阿司匹林直至OPCABG或CABG当天的患者倾向评分匹配队列与对照组(未使用抗血小板药物)以及提前5 - 7天停用阿司匹林的患者进行了比较。OPCABG和CABG患者的住院时间、30天死亡率和血栓栓塞率相似。在OPCABG期间,持续使用阿司匹林的患者术中接受的红细胞单位比对照组多,出血情况无差异。持续使用阿司匹林的患者围手术期接受的血液制品更多,且比接受OPCABG的停用阿司匹林患者出血更多。CABG期间唯一的差异是,与对照组相比,持续使用阿司匹林的患者回收的细胞体积略有增加。当前关于CABG和OPCABG前继续使用阿司匹林的指南是安全的。OPCABG前继续使用阿司匹林可能导致更多出血和血液制品使用。