Gupta Aashray K, Zaka Ammar, Lombardo Alexander, Tsimiklis James, Stretton Brandon, Kovoor Joshua G, Bacchi Stephen, Ramponi Fabio, Chan Justin C Y, Thiagalingam Aravinda, Gould Paul, Sivagangabalan Gopal, Zaman Sarah, Chow Clara, Kovoor Pramesh, Smith Julian A, Bennetts Jayme S, Maddern Guy J
Discipline of Surgery, University of Adelaide, Adelaide, Australia.
Gold Coast University Hospital, Southport, Australia.
Surgery. 2025 Apr;180:109003. doi: 10.1016/j.surg.2024.109003. Epub 2024 Dec 20.
The decision to continue aspirin before elective coronary artery bypass graft surgery remains contentious because of competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between patients undergoing coronary artery bypass grafting who stopped and continued aspirin before surgery.
PubMed, MEDLINE, and CENTRAL databases were searched from inception to 4 October 2023 for randomized controlled trials comparing patients undergoing coronary artery bypass grafting who continued preoperative aspirin with those who discontinued before surgery. Studies with cointervention arms and multivariable-adjusted or propensity matched observational studies were excluded. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity.
Fifteen eligible randomized controlled trials were included with a total of 6,188 patients. Patients who continued aspirin demonstrated no significant difference in all-cause mortality (odds ratio, 1.37; confidence interval, 0.81-2.33), perioperative myocardial infarction (odds ratio, 0.81; confidence interval, 0.55-1.18), and postoperative blood loss (mean difference, 66.12 mL; confidence interval, -1.45 to 133.69). No significant difference was observed between low-dose and greater doses of aspirin. There was minimal heterogeneity amongst included studies (I = 0%, P = .97, I = 33%, P = .13, and I= 76, P = .06, respectively). Studies were of low methodologic quality according to Cochrane Risk of Bias for Randomized Trials.
This largest to-date systematic review and meta-analysis found no significant difference for risk of all-cause mortality, perioperative myocardial infarction, and postoperative bleeding between patients continuing and stopping aspirin before coronary artery bypass grafting.
由于存在血栓形成和出血风险的权衡，在择期冠状动脉旁路移植手术前继续使用阿司匹林的决定仍存在争议。我们进行了一项当代系统评价和荟萃分析，以比较冠状动脉旁路移植手术患者在术前停用和继续使用阿司匹林的结局。
检索了PubMed、MEDLINE和CENTRAL数据库，从数据库建立至2023年10月4日，查找比较冠状动脉旁路移植手术患者术前继续使用阿司匹林与术前停用阿司匹林的随机对照试验。排除有联合干预组以及多变量调整或倾向匹配观察性研究的试验。使用随机效应模型计算二分变量和连续变量的汇总比值比。进行亚组分析和敏感性分析以探索异质性来源。
纳入了15项符合条件的随机对照试验，共6188例患者。继续使用阿司匹林的患者在全因死亡率（比值比，1.37；置信区间，0.81-2.33）、围手术期心肌梗死（比值比，0.81；置信区间，0.55-1.18）和术后失血量（平均差异，66.12 mL；置信区间，-1.45至133.69）方面无显著差异。低剂量和高剂量阿司匹林之间未观察到显著差异。纳入研究之间的异质性最小（I²分别为0%，P = 0.97；I²为33%，P = 0.13；I²为76，P = 0.06）。根据Cochrane随机试验偏倚风险评估，研究的方法学质量较低。
这项迄今为止最大规模的系统评价和荟萃分析发现，冠状动脉旁路移植手术前继续使用和停用阿司匹林的患者在全因死亡率、围手术期心肌梗死和术后出血风险方面无显著差异。
