Aspirin before heart surgery?
According to a study by researchers at Thomas Jefferson University and UC Davis Medical Center, aspirin taken within five days of cardiac surgery is associated with a significant decrease in the risk of major postoperative complications, including renal failure, a lengthy intensive care unit stay and even death. The research team evaluated the impact of preoperative aspirin on major outcomes in 4,256 adults who had cardiac surgery — mostly coronary artery bypass graft or valve surgery — at the two institutions between 2001 and 2009.
What the news means to you
This observational study has drawbacks that warrant further analysis.
Surgeons frequently tell patients to stop taking aspirin five days prior to heart surgery due to increased risk of bleeding. This is also true for patients who take anti-platelet agents such as Plavix, which can also increase the risk of bleeding.
The current research study demonstrates a statistically significant risk reduction in post-operative complications and even death during the month following surgery, for the patients who took at least one aspirin during the five days before surgery. However, it is not clear if the aspirin users were also benefitting from other modifying therapies such as diet, beta blockers or anti-cholesterol medications, which may have also influenced the outcomes.
There is also a mix of patients who received valves, coronary artery bypass grafts (CABG) and other surgeries in this study. We know from the risk models that we use at Yale-New Haven Hospital that different surgeries carry different risks depending on the technical nature of the surgery. One of the main ways aspirin works is by making the blood platelets less sticky so that clots do not form in vessels that are important to maintain organ circulation, such as the brain and heart. The natural effect of this is increased bleeding when any invasive procedure is performed, be it a heart surgery or any other type of surgery.
I often perform surgery on patients who have conditions that warrant their continued use of aspirin and Plavix until the day of surgery. On the other hand, it is prudent for patients undergoing elective heart surgery to avoid unnecessary risk of blood transfusion and transfusion-related risks by stopping aspirin five days prior to their heart surgery.
This observational study has drawbacks that warrant further analysis of large-scale registry data before we can routinely advocate for pre-operative aspirin for heart surgery patients.
No two patients are alike. And the care for each patient needs to be customized to suit the needs of that patient whether he or she needs minimally invasive surgery or a more conventional approach for CABG or valve surgery.
The cardiac surgery program at YNHH offers state-of-the-art treatment for acquired cardiac disease, including hybrid coronary interventions, minimally invasive and robot surgery, operations for cardiac arrhythmias and the newest generation of mechanical cardiac assist devices for end-stage heart failure.
Pramod Bonde, MD, is the surgical director of mechanical and circulatory support at Yale-New Haven Hospital and associate program director for the cardio-thoracic surgical residency training program at Yale School of Medicine.