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.
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.
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.
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.
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.
Yatin Mehta, None.