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Preoperative Aspirin Therapy and Reoperation for Bleeding After Coronary Artery Bypass Surgery

Preoperative Aspirin Therapy and Reoperation for Bleeding After Coronary Artery Bypass Surgery Abstract We performed a case-control study to estimate the relative risk of reoperation for bleeding in coronary artery bypass graft patients who had taken aspirin within the 7 days preceding sur gery. Comparison of 90 cases of reoperation with 180 matched control subjects gave an estimated odds ratio for reoperation of 1082 (95% confidence interval, 1.23 to 3.32). Although their preop erative coagulation values were similar, cases used significantly more whole blood (cases, 9.5 + 5.2 units; control subjects, 3.0 + 2.0 units; median + interquartile range), packed red blood cells (cases, 2.1 + 4.0 units; control subjects, 0.9 +- 2.0 units), and platelets (cases, 12.2 +- 12.0 units; control subjects, 2.9 +- 4.0 units) than control subjects. Cases had intensive care unit stays of 4.7 +- 5.7 days (mean SD) vs 2.1 1.9 days for control subjects and postoperative hospitalizations of 10.9 +- 8.2 days vs 7.0 +- 3.2 days for control subjects. We conclude that aspirin exposure within 7 days before coronary bypass surgery is asso ciated with an increased rate of reoperation for bleeding and that reoperation is associated with large increases in transfusion requirements and intensive care unit and hospital stays. (Arch Intern Med. 1991;151:89-93) References 1. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina: results of a Canadian multicenter trial . N Engl J Med. 1985;313:1369-1375.Crossref 2. Harker LA. Clinical trials evaluating platelet-modifying drugs in patients with atherosclerotic cardiovascular disease and thrombosis . Circulation. 1986;73:206-223.Crossref 3. Michelson EL, Morganroth J, Torosian M, MacVaugh H III. Relation of preoperative use of aspirin to increased mediastinal blood loss after coronary artery bypass graft surgery . J Thorac Cardiovasc Surg. 1978;76:694-697. 4. Torosian M, Michelson EL, Morganroth J, et al. Aspirin and coumadinrelated bleeding after coronary-artery bypass graft surgery . Ann Intern Med. 1978;89:325-328.Crossref 5. Ferraris VA, Ferraris SP, Lough FC, Berry WR. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting . Ann Thorac Surg. 1988;45:71-74.Crossref 6. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration cooperative study . Circulation. 1988;77:1324-1332.Crossref 7. Sethi GK, Copeland JG, Goldman S, et al. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass graft ing . J Am Coll Cardiol. 1990;15:15-20.Crossref 8. Karwande SV, Weksler BB, Gay WA, Subramanian VA. Effect of preop erative antiplatelet drugs on vascular prostacyclin synthesis . Ann Thorac Surg. 1987;43:318-322.Crossref 9. Giordano GF, Giordano GF Jr, Rivers SL, et al. Determinants of homolo gous blood usage utilizing autologous platelet-rich plasma in cardiac operations . Ann Thorac Surg. 1989;47:897-902.Crossref 10. Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina . N Engl J Med. 1988;319:1105-1111.Crossref 11. Bashein G, Barna CR. A comprehensive computer system for anesthetic record retrieval . Anesth Analg. 1985;64:425-443.Crossref 12. Schlesselman JJ. Case-Control Studies . New York, NY: Oxford Univer sity Press Inc; 1982. 13. Weiss HJ. Platelets: Pathophysiology and Antiplatelet Drug Therapy . New York, NY: Alan R Liss Inc; 1982:45-73. 14. Hindman BJ, Koka BV. Usefulness of the post-aspirin bleeding time . Anesthesiology. 1986;64:368-370.Crossref 15. Killip T. Twenty years of coronary artery bypass surgery . N Engl J Med. 1988;319:366-368.Crossref 16. Harker LA. Bleeding after cardiopulmonary bypass . N Engl J Med. 1986;314:1446-1448.Crossref 17. Taylor GL, Mikell FL, Moses HW, et al. Determinants of hospital changes for coronary artery bypass surgery: the economic consequences of postoperative complications . Am J Cardiol. 1990;65:309-313.Crossref 18. Ramsey G, Arvan DA, Steward S, Blumberg N. Do preoperative labora tory tests predict blood transfusion needs in cardiac operations? J Thorac Cardiovasc Surg. 1983;85:564-569. 19. Feinstein AR, Horwitz RI. Double standards, scientific methods, and epidemiologic research . N Engl J Med. 1982;307:1611-1617.Crossref 20. Sackett DL. Bias in analytic research . J Chronic Dis. 1979;32:51-63.Crossref 21. Cosgrove DM, Loop FD, Lytle BW, et al. Determinants of blood utiliza tion during myocardial revascularization . Ann Thorac Surg. 1985;40:380-384.Crossref 22. De Caterina R, Giannessi D, Boem A, et al. Equal antiplatelet effects of aspirin 50 or 324 mg/day in patients after acute myocardial infarction . Thromb Haemost. 1985;54:528-532. 23. Boss AH, Boysen G, Olsen JS. Effect of incremental doses of aspirin on bleeding time, platelet aggregation and thromboxane production in patients with cerebrovascular disease . Eur J Clin Invest. 1983;15:412-414.Crossref 24. McLeod LJ, Roberts MS, Cossum PA, Vial JH. The effects of different doses of some acetylsalicylic acid formulations on platelet function and bleeding times in healthy subjects . Scand J Haematol. 1986;36:379-384.Crossref 25. Zucker ML, Trowbridge C, Woodroof J, et al. Low- vs high-dose aspirin: effects on platelet function in hyperlipoproteinemic and normal subjects . Arch Intern Med. 1986;146:921-925.Crossref 26. Stampfer MJ, Jakubowski JA, Deykin D, Schafer AI, Willett WC, Hennekens CH. Effect of alternate-day regular and enteric-coated aspirin on platelet aggregation, bleeding time, and thromboxane A2 levels in blood . Am J Med. 1986;81:400-404.Crossref 27. Mielke CH, Britten AFH. Aspirin: a new nightmare for blood bankers . N Engl J Med. 1971;286:268-269. 28. McCann WP, McGowan EI, Burnett OL, Palmisano PA. Serum salicylate levels in blood donors . JAMA. 1970;214:753-754.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Preoperative Aspirin Therapy and Reoperation for Bleeding After Coronary Artery Bypass Surgery

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400010105014
Publisher site
See Article on Publisher Site

Abstract

Abstract We performed a case-control study to estimate the relative risk of reoperation for bleeding in coronary artery bypass graft patients who had taken aspirin within the 7 days preceding sur gery. Comparison of 90 cases of reoperation with 180 matched control subjects gave an estimated odds ratio for reoperation of 1082 (95% confidence interval, 1.23 to 3.32). Although their preop erative coagulation values were similar, cases used significantly more whole blood (cases, 9.5 + 5.2 units; control subjects, 3.0 + 2.0 units; median + interquartile range), packed red blood cells (cases, 2.1 + 4.0 units; control subjects, 0.9 +- 2.0 units), and platelets (cases, 12.2 +- 12.0 units; control subjects, 2.9 +- 4.0 units) than control subjects. Cases had intensive care unit stays of 4.7 +- 5.7 days (mean SD) vs 2.1 1.9 days for control subjects and postoperative hospitalizations of 10.9 +- 8.2 days vs 7.0 +- 3.2 days for control subjects. We conclude that aspirin exposure within 7 days before coronary bypass surgery is asso ciated with an increased rate of reoperation for bleeding and that reoperation is associated with large increases in transfusion requirements and intensive care unit and hospital stays. (Arch Intern Med. 1991;151:89-93) References 1. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina: results of a Canadian multicenter trial . N Engl J Med. 1985;313:1369-1375.Crossref 2. Harker LA. Clinical trials evaluating platelet-modifying drugs in patients with atherosclerotic cardiovascular disease and thrombosis . Circulation. 1986;73:206-223.Crossref 3. Michelson EL, Morganroth J, Torosian M, MacVaugh H III. Relation of preoperative use of aspirin to increased mediastinal blood loss after coronary artery bypass graft surgery . J Thorac Cardiovasc Surg. 1978;76:694-697. 4. Torosian M, Michelson EL, Morganroth J, et al. Aspirin and coumadinrelated bleeding after coronary-artery bypass graft surgery . Ann Intern Med. 1978;89:325-328.Crossref 5. Ferraris VA, Ferraris SP, Lough FC, Berry WR. Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting . Ann Thorac Surg. 1988;45:71-74.Crossref 6. Goldman S, Copeland J, Moritz T, et al. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration cooperative study . Circulation. 1988;77:1324-1332.Crossref 7. Sethi GK, Copeland JG, Goldman S, et al. Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass graft ing . J Am Coll Cardiol. 1990;15:15-20.Crossref 8. Karwande SV, Weksler BB, Gay WA, Subramanian VA. Effect of preop erative antiplatelet drugs on vascular prostacyclin synthesis . Ann Thorac Surg. 1987;43:318-322.Crossref 9. Giordano GF, Giordano GF Jr, Rivers SL, et al. Determinants of homolo gous blood usage utilizing autologous platelet-rich plasma in cardiac operations . Ann Thorac Surg. 1989;47:897-902.Crossref 10. Theroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina . N Engl J Med. 1988;319:1105-1111.Crossref 11. Bashein G, Barna CR. A comprehensive computer system for anesthetic record retrieval . Anesth Analg. 1985;64:425-443.Crossref 12. Schlesselman JJ. Case-Control Studies . New York, NY: Oxford Univer sity Press Inc; 1982. 13. Weiss HJ. Platelets: Pathophysiology and Antiplatelet Drug Therapy . New York, NY: Alan R Liss Inc; 1982:45-73. 14. Hindman BJ, Koka BV. Usefulness of the post-aspirin bleeding time . Anesthesiology. 1986;64:368-370.Crossref 15. Killip T. Twenty years of coronary artery bypass surgery . N Engl J Med. 1988;319:366-368.Crossref 16. Harker LA. Bleeding after cardiopulmonary bypass . N Engl J Med. 1986;314:1446-1448.Crossref 17. Taylor GL, Mikell FL, Moses HW, et al. Determinants of hospital changes for coronary artery bypass surgery: the economic consequences of postoperative complications . Am J Cardiol. 1990;65:309-313.Crossref 18. Ramsey G, Arvan DA, Steward S, Blumberg N. Do preoperative labora tory tests predict blood transfusion needs in cardiac operations? J Thorac Cardiovasc Surg. 1983;85:564-569. 19. Feinstein AR, Horwitz RI. Double standards, scientific methods, and epidemiologic research . N Engl J Med. 1982;307:1611-1617.Crossref 20. Sackett DL. Bias in analytic research . J Chronic Dis. 1979;32:51-63.Crossref 21. Cosgrove DM, Loop FD, Lytle BW, et al. Determinants of blood utiliza tion during myocardial revascularization . Ann Thorac Surg. 1985;40:380-384.Crossref 22. De Caterina R, Giannessi D, Boem A, et al. Equal antiplatelet effects of aspirin 50 or 324 mg/day in patients after acute myocardial infarction . Thromb Haemost. 1985;54:528-532. 23. Boss AH, Boysen G, Olsen JS. Effect of incremental doses of aspirin on bleeding time, platelet aggregation and thromboxane production in patients with cerebrovascular disease . Eur J Clin Invest. 1983;15:412-414.Crossref 24. McLeod LJ, Roberts MS, Cossum PA, Vial JH. The effects of different doses of some acetylsalicylic acid formulations on platelet function and bleeding times in healthy subjects . Scand J Haematol. 1986;36:379-384.Crossref 25. Zucker ML, Trowbridge C, Woodroof J, et al. Low- vs high-dose aspirin: effects on platelet function in hyperlipoproteinemic and normal subjects . Arch Intern Med. 1986;146:921-925.Crossref 26. Stampfer MJ, Jakubowski JA, Deykin D, Schafer AI, Willett WC, Hennekens CH. Effect of alternate-day regular and enteric-coated aspirin on platelet aggregation, bleeding time, and thromboxane A2 levels in blood . Am J Med. 1986;81:400-404.Crossref 27. Mielke CH, Britten AFH. Aspirin: a new nightmare for blood bankers . N Engl J Med. 1971;286:268-269. 28. McCann WP, McGowan EI, Burnett OL, Palmisano PA. Serum salicylate levels in blood donors . JAMA. 1970;214:753-754.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jan 1, 1991

References

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