Professor Julian Smith presented his recent The New England Journal of Medicine findings about aspirin and coronary artery bypass surgery at the European Association For Cardiothoracic Surgery (EACTS) Meeting in Barcelona last month.
Head of Department of Surgery at the School of Clinical Sciences at Monash Health, Professor Smith and his colleagues showed that patients who take aspirin before heart surgery are at no greater risk of bleeding or complications.
“Many patients with coronary artery disease are taking aspirin for primary or secondary prevention of myocardial infarction, stroke and death,” said Professor Smith.
“Aspirin taken at the time of coronary artery bypass surgery (CABG) creates a potential risk of excessive bleeding.”
“To date, there has been a lack of evidence as to whether or not aspirin should be ceased prior to CABG and traditionally most centres tended to withhold aspirin for 5 to 7 days in the lead up to CABG,” said Professor Smith.
The collaborative multi-centre international study (19 hospitals in five countries) was conducted to investigate whether stopping or continuing aspirin before CABG posed more risks or benefits.
The study, as part of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial, randomly assigned 2100 patients scheduled for CABG and at risk for post-operative complications to receive aspirin or placebo and tranexamic acid or placebo.
Professor Smith said the patients were randomly assigned to receive 100mg of aspirin or a matched placebo preoperatively.
“The 100mg dose was deemed to have the strongest evidence of preventative efficacy (at least in nonsurgical settings) balanced against a low risk of bleeding complications.”
“The primary outcome measure was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or intestinal infarction) within 30 days following surgery,” said Professor Smith.
The researchers concluded for patients undergoing CABG that the administration of aspirin preoperatively neither lowered the risk of death or thrombotic complications nor raised the risk of bleeding compared with placebo.
“Significantly, our study shows for the first time that there is no reason to cease aspirin prior to CABG, although an important caveat to this recommendation is for patients with a pre-existing bleeding disorder or possessing other major risk factors for bleeding,” said Professor Smith.