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Abstract: Poster Presentations |

SAFETY AND EFFICACY OF IMMEDIATE POSTOPERATIVE ASPIRIN IN OFF PUMP CORONARY ARTERY BYPASS GRAFTING PATIENTS FREE TO VIEW

Yatin Mehta, MD*; Satish Kumar, MD; Altaf Bukhari, MD; Mayank Vats, MD; Naresh Trehan, MD
Author and Funding Information

Escorts Heart Institute and Research Center, New Delhi, India


Chest


Chest. 2005;128(4_MeetingAbstracts):272S. doi:10.1378/chest.128.4_MeetingAbstracts.272S
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Abstract

PURPOSE:  Preoperative aspirin administration, which is continued during the postoperative period in Coronary Artery Bypass Grafting (CABG) patients, has resulted in improvement in early as-well-as late graft patency. However the precise complication rate as a result of immediate (i.e. within 24-hours) postoperative administration of aspirin has not been fully evaluated especially in Off-Pump-CABG(OPCAB) patients and the existing data has conflicting results.The aim of this study was to evaluate safety and efficacy of immediate postoperative aspirin (i.e. <24 hours) in OPCABG.

METHODS:  Out of 887 patients, who underwent OPCAB, only 750 patients fulfilled the inclusion criteria and randomized into group-A (aspirin with-in first 24 hrs) and group-B (placebo till chest-tubes removal & then aspirin). Complete preoperative evaluation was done and surgical/anesthetic techniques were same in both group. Primary end-points of study were:-Inhospital mortality, perioperative Myocardial Infarction (PMI), stroke, cerebral hemorrhage, reexploration and gastrointestinal ischemia and hemorrhage. Seondary end-points were-amount of mediastinal bleeding, blood/blood product transfusion and length of ICU/hospital stay.

RESULTS:  Both groups were statistically similar regarding demographic, comorbidities, preoperative anti platelet/anticoagulation and other cardiac-medications and total platelet-count. Outcome measures in group A & B respectively were:Mortality–1.6% v/s 0.5% p-0.286, PMI-2.7% v/s2.5% p-0.125,GI bleeding–1.1%v/s0.8% p-0.699, stroke 0.3% v/s0.3% p-1,Renal failure-3.5% v/s2.7%,p0.525, mediastinal drainage 307.7±30.5ml v/s298.3± 29.3 ml p-001, reexploration3.5% v/s1.1% p-0.5, ICU stay 2.3±0.9v/s2.09 ±.0.8days, p-0.001. Blood/blood products transfusion requirement in group A&B were: whole blood 0.76±1.23v/s0.60±0.90Units p0.04, platelet concentrate 1.2±0.8 v/s0.6±0.31Units p< 0.001, Fresh Frozen Plasma2.67± 0.21v/s1.33±0.14 Units P< 0.001, PRBC 3.8± 1.9 v/s1.7 ± 1.2Units P< 0.001.

CONCLUSION:  We conclude that early aspirin therapy i.e within 24 hours after OPCAB may not be beneficial in prevention of postoperative inflammatory injury rather it may increase the incidence of bleeding, blood/blood product requirement and re-exploration and other adverse outcome.

CLINICAL IMPLICATIONS:  Immediate postoperative administration of aspirin in OPCAB patients should be avoided and the risk benefit ratio of early aspirin therapy in OPCAB should be evaluated in double-blinded, Randomised-Controlled-Trials.

DISCLOSURE:  Yatin Mehta, None.

Wednesday, November 2, 2005

12:30 PM - 2:00 PM


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