Impact of aspirin on bleeding and blood product usage in off-pump and on-pump coronary artery bypass graft surgery.
Impact of aspirin on bleeding and blood product usage in off-pump and on-pump coronary artery bypass graft surgery.
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DOI：
10.1002/jha2.400
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发表时间：
2022-05
期刊：
影响因子：
--
通讯作者：
Arachchillage, Deepa R. J.
中科院分区：
文献类型：
--
作者：
Little, Christopher;Odho, Zain;Szydlo, Richard;Aw, Tuan-Chen;Laffan, Mike;Arachchillage, Deepa R. J.
大出血与心脏手术后较差的结果有关。目前的指南建议在冠状动脉旁路移植术（CABG）前继续服用阿司匹林，但对于既往有阿司匹林适应证的患者，特别是在非体外循环CABG（OPCABG）期间，继续服用阿司匹林的效果尚未得到系统评估。在这项研究中，我们分析了 OPCABG 和体外循环 CABG 之前持续服用阿司匹林对出血和血液制品使用的影响。我们将持续服用阿司匹林直至 OPCABG 或 CABG 当天的患者与对照组（无抗血小板药物）以及 5-7 天前停用阿司匹林的患者进行倾向匹配队列比较。 OPCABG 和 CABG 的住院时间、30 天死亡率和血栓栓塞率相似。在 OPCABG 期间，与对照组相比，继续服用阿司匹林的患者接受了更多的术中红细胞单位，但出血情况没有差异。继续服用阿司匹林的患者比接受 OPCABG 的停用阿司匹林的患者在围手术期接受了更多的血液制品，出血量也更多。与对照组相比，CABG 期间唯一的差异是继续服用阿司匹林的患者挽救的细胞体积略有增加。目前关于在 CABG 和 OPCABG 之前继续服用阿司匹林的指南是安全的。在 OPCABG 之前继续服用阿司匹林可能会导致更多的出血和血液制品的使用。
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.
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