Aspirin before surgery helps heart patients

Aspirin taken within five days before cardiac surgery is associated with a lower risk of complications and may even reduce the risk of early death, a new study shows. The findings are significant because despite remarkable progress in cardiac surgery, the number of major complications from cardiac surgery remains high, according to research reported in Annals of Surgery. “Therapies targeted to prevent or reduce major complications associated with cardiac surgery have been few and ineffective so far,” says Jianzhong Sun, an anesthesiologist at Thomas Jefferson University and lead author of the study. “These complications are significant and costly both for the public health and the quality of patient life.” The study team evaluated the impact of preoperative aspirin on major outcomes in adults (total 4,256 consecutive patients) who had cardiac surgery—mostly coronary artery bypass graft or valve surgery—at Thomas Jefferson University Hospital or University of California, Davis Medical Center between 2001 and 2009. Among 2,868 patients who met the inclusion criteria, 1,923 took aspirin (about 81 to 325 mg daily) at least once within five days preceding their surgery versus 945 not taking aspirin (non-aspirin therapy). The outcomes showed that preoperative aspirin therapy (vs. non-aspirin) is associated with a significant decrease in the risk for 30-day mortality, major adverse cardiocerebral events, postoperative renal failure, and average time spent in the intensive care unit. Beneficial effects of preoperative aspirin use found in the current study “are in line with our previous findings and findings from early postoperative aspirin studies,” wrote Sun and colleagues in the paper. “We know that aspirin can be lifesaving for patients who have experienced heart attacks,” says co-author Nilas Young, chief of cardiothoracic surgery at UC Davis. “Now we know that this simple intervention can do the same for patients who undergo certain coronary surgeries. This outcome could lead to new preoperative treatment standards in cardiac medicine.” While bleeding remains a concern with preoperative aspirin therapy, it may be avoided by using antifibrinolytic therapy, which prevents the breakdown of clotting factors in the blood, and/or a low dose of aspirin. “Overall, the outcome benefits provided by preoperative aspirin therapy may override its possible risk of excess bleeding in patients undergoing cardiac surgery. Nonetheless, further studies are certainly needed to examine this potential side effect carefully,” the researchers write. “While we are excited that the study clearly showed that preoperative use of aspirin significantly reduced major complications and mortality in patients undergoing cardiac surgery,” says Zvi Grunwald, chair of anesthesiology at Jefferson,  “we do urge further study before recommending aspirin for cardiac surgery patients prior to surgery.”