Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting

Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting

VA Ferraris, SP Ferraris, FC Lough and WR Berry
Department of Surgery, Letterman Army Medical Center, Presidio of San Francisco, CA 94129-6700.

Thirty-four patients were entered into a non-blinded, randomized study to test the effect of preoperative aspirin ingestion on postoperative blood loss and transfusion requirements after coronary artery bypass grafting. Sixteen patients in the aspirin-treated group had significantly increased chest-tube blood loss 12 hours after operation (1,513 +/- 978 versus 916 +/- 482 ml; p = 0.038). In addition, aspirin users had significantly increased requirements for postoperative packed red blood cells (4.4 +/- 3.5 versus 1.8 +/- 1.3 units; p = 0.014), platelets (1.3 +/- 1.3 versus 0.2 +/- 0.4 six-donor units, p = 0.0049), and fresh-frozen plasma (3.6 +/- 5.0 versus 0.78 +/- 1.6 units; p = 0.042) transfusions. The only patients requiring reoperation for bleeding were in the aspirin-treated group (2 patients). Six patients were not entered into the randomized part of the study because of excessively prolonged post-aspirin bleeding times (greater than 10 minutes). This finding suggests that a subset of patients are particularly sensitive to aspirin and have significantly prolonged bleeding times after aspirin ingestion. We conclude that aspirin ingestion increases postoperative blood loss and transfusion requirements, and we recommend discontinuation of aspirin therapy before cardiac procedures.

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				J. C.J. Sun, R. Whitlock, J. Cheng, J. W. Eikelboom, L. Thabane, M. A. Crowther, and K. H.T. Teoh The effect of pre-operative aspirin on bleeding, transfusion, myocardial infarction, and mortality in coronary artery bypass surgery: a systematic review of randomized and observational studies Eur. Heart J., April 2, 2008; 29(8): 1057 - 1071. [Abstract] [Full Text] [PDF]

				Z. I. Khalpey, R. B. Ganim, and J. D. Rawn Postoperative Care of Cardiac Surgery Patients Card. Surg. Adult, January 1, 2008; 3(2008): 465 - 486. [Full Text]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

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				C. P. Cannon, S. R. Mehta, and S. F. Aranki Balancing the Benefit and Risk of Oral Antiplatelet Agents in Coronary Artery Bypass Surgery Ann. Thorac. Surg., August 1, 2005; 80(2): 768 - 779. [Abstract] [Full Text] [PDF]

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				V. A. Ferraris, S. P. Ferraris, D. J. Moliterno, P. Camp, J. M. Walenga, H. L. Messmore, W. P. Jeske, F. H. Edwards, D. Royston, D. M. Shahian, et al. The Society of Thoracic Surgeons Practice Guideline Series: Aspirin and Other Antiplatelet Agents During Operative Coronary Revascularization (Executive Summary) Ann. Thorac. Surg., April 1, 2005; 79(4): 1454 - 1461. [Full Text] [PDF]

				D. M. Moskowitz, J. J. Klein, A. Shander, K. M. Cousineau, R. S. Goldweit, C. Bodian, S. I. Perelman, H. Kang, D. A. Fink, H. C. Rothman, et al. Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center Ann. Thorac. Surg., February 1, 2004; 77(2): 626 - 634. [Abstract] [Full Text] [PDF]

				T. Mueller, M. Haltmayer, W. Poelz, and D. Haidinger Monitoring Aspirin 1 00 mg and Clopidogrel 75 mg Therapy with the PFA-1 00 Device in Patients with Peripheral Arterial Disease Vascular and Endovascular Surgery, March 1, 2003; 37(2): 117 - 123. [Abstract] [PDF]

				F. J.F. Herth, H.D. Becker, and A. Ernst Aspirin Does Not Increase Bleeding Complications After Transbronchial Biopsy Chest, October 1, 2002; 122(4): 1461 - 1464. [Abstract] [Full Text] [PDF]

				R. H. Hongo, J. Ley, S. E. Dick, and R. R. Yee The effect of clopidogrel incombination with aspirin whengiven before coronary artery bypass grafting J. Am. Coll. Cardiol., July 17, 2002; 40(2): 231 - 237. [Abstract] [Full Text] [PDF]

				J. M. Alvarez, L. R. Jackson, C. Chatwin, and J. J. Smolich Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: A prospective, randomized, double-blind, placebo-controlled trial J. Thorac. Cardiovasc. Surg., September 1, 2001; 122(3): 457 - 463. [Abstract] [Full Text] [PDF]

				L. ARDEKIAN, R. GASPAR, M. PELED, B. BRENER, and D. LAUFER DOES LOW-DOSE ASPIRIN THERAPY COMPLICATE ORAL SURGICAL PROCEDURES? J Am Dent Assoc, March 1, 2000; 131(3): 331 - 335. [Abstract] [Full Text] [PDF]

				S. V Moran, G. Lema, J. Medel, M. J Irarrazaval, R. Zalaquett, B. Garayar, and R. Flaskamp Comparison of two doses of aprotinin in patients receiving aspirin before coronary bypass surgery Perfusion, March 1, 2000; 15(2): 105 - 110. [Abstract] [PDF]

				B. P. Bidstrup, B. J. Hunt, S. Sheikh, R. N. Parratt, J. M. Bidstrup, and R. N. Sapsford Amelioration of the bleeding tendency of preoperative aspirin after aortocoronary bypass grafting Ann. Thorac. Surg., February 1, 2000; 69(2): 541 - 547. [Abstract] [Full Text] [PDF]

				G. L. Early and S. R. Roberts Excellence and low case volume: an example of the inapplicability of volume-based credentialing Ann. Thorac. Surg., January 1, 2000; 69(1): 146 - 150. [Abstract] [Full Text] [PDF]

				Drugs in the peri-operative period: 4 - Cardiovascular drugs DTB, December 1, 1999; 37(12): 89 - 92. [Abstract] [Full Text] [PDF]

				M. Klein, P.R. Keith, H.-P. Dauben, H.D. Schulte, H. Beckmann, G. Mayer, O. Elert, and E. Gams Aprotinin counterbalances an increased risk of peri-operative haemorrhage in CABG patients pre-treated with Aspirin Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 360 - 366. [Abstract] [Full Text] [PDF]

				P. G. M. Jansen, C. Baufreton, P. Le Besnerais, D. Y. Loisance, and C. R. H. Wildevuur Heparin-Coated Circuits and Aprotinin Prime for Coronary Artery Bypass Grafting Ann. Thorac. Surg., May 1, 1996; 61(5): 1363 - 1366. [Abstract] [Full Text]

ARTICLES

Preoperative aspirin ingestion increases operative blood loss after coronary artery bypass grafting

				M. J. Moulton, L. L. Creswell, M. E. Mackey, J. L. Cox, and M. Rosenbloom REEXPLORATION FOR BLEEDING IS A RISK FACTOR FOR ADVERSE OUTCOMES AFTER CARDIAC OPERATIONS J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 1037 - 1046. [Abstract] [Full Text]

				C. C. Otley, J. L. Fewkes, W. Frank, and S. M. Olbricht Complications of Cutaneous Surgery in Patients Who Are Taking Warfarin, Aspirin, or Nonsteroidal Anti-inflammatory Drugs Arch Dermatol, February 1, 1996; 132(2): 161 - 166. [Abstract] [PDF]

				J. I. Casas, I. Zuazu-Jausoro, J. Mateo, A. Oliver, H. Litvan, E. Muniz-Diaz, A. Aris, J. M. Caralps, and J. Fontcuberta APROTININ VERSUS DESMOPRESSIN FOR PATIENTS UNDERGOING OPERATIONS WITH CARDIOPULMONARY BYPASS: A double-blind placebo-controlled study J. Thorac. Cardiovasc. Surg., October 1, 1995; 110(4): 1107 - 1117. [Abstract] [Full Text]

				N. Tabuchi, R. C. G. Gallandat Huet, A. Sturk, L. Eijsman, and C. R. H. Wildevuur Hemostatic function of aspirin-treated platelets vulnerable to cardiopulmonary bypassAltered shear-induced pathway J. Thorac. Cardiovasc. Surg., September 1, 1995; 110(3): 813 - 818. [Abstract] [Full Text]

				V. Ferraris Preoperative Aspirin Ingestion Increases Operative Blood Loss after Coronary Artery Bypass Grafting Ann. Thorac. Surg., April 1, 1995; 59(4): 1036 - 1037. [Full Text]

				J. M. Murkin, J. Lux, N. A. Shannon, G. M. Guiraudon, A. H. Menkis, F. N. McKenzie, and R. J. Novick Aprotinin significantly decreases bleeding and transfusion requirements in patients receiving aspirin and undergoing cardiac operations J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 554 - 561. [Abstract] [Full Text]

				R. D Weisel Agents that modify haemostasis after cardiopulmonary bypass Perfusion, May 1, 1993; 8(1_suppl): 6 - 12. [Abstract] [PDF]

				C. Prentice, M. Orchard, and C. Goodchild Haemostatic dysfunction and cardiopulmonary bypass: mechanisms and therapeutic choices Perfusion, May 1, 1993; 8(1_suppl): 28 - 35. [Abstract] [PDF]

				D. M Cosgrove Use of aprotinin in repeat myocardial revascularization: Cleveland Clinic experience Perfusion, May 1, 1993; 8(1_suppl): 36 - 42. [Abstract] [PDF]

				G. Bashein, M. L. Nessly, A. L. Rice, R. B. Counts, and G. A. Misbach Preoperative Aspirin Therapy and Reoperation for Bleeding After Coronary Artery Bypass Surgery Arch Intern Med, January 1, 1991; 151(1): 89 - 93. [Abstract] [PDF]