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DOI: 10.1055/s-2004-816804
Preoperative acetylsalicylic acid increases blood transfusions in CABG on CPB
Objectives: Bleeding after heart operations remains a common complication and contributes to morbidity and death. Recent studies have demonstrated that acetylsalicylic acid (ASA) does not increase homologous blood requirements in coronary bypass surgery. The purpose of this study was to reexamine the influence of ASA therapy on hemorrhage and transfusion requirements in patients undergoing CABG on CPB.
Material and Methods: Records from 300 patients who underwent CABG with cardiopulmonary bypass were retrospectively reviewed, including 150 patients who received ASA within 5 days prior to surgery and 150 control patients (CON). Perioperative blood products were transfused in a standardized fashion. Blood loss was measured up to 24 hours. Demographic and clinical patient data were collected until hospital discharge.
Results: Cardiopulmonary bypass duration, procedure length, aortic cross-clamp time, and number of grafts performed did not differ significantly between groups. 4 ASA patients and 5 CON patients required reexploration for bleeding. 16 ASA patients and 5 CON patients suffered from postoperative pneumonia, which is significantly (p=0.02) different between groups. There was significantly (p<0.005) more mediastinal tube drainage at 24h in the ASA group (1123±537ml) compared to CON patients (874±351ml). In addition, there were significant differences in units of blood transfused postoperatively (ASA: 1.4±1.8 vs. CON: 0.8±1.3; p<0.005) and platelets intraoperatively (ASA: 0.7±1.4 vs. CON: 0.2±0.8; p<0.005) and postoperatively (ASA: 0.5±1.3 vs. CON: 0.05±0.4; p<0.005) between the groups.
Conclusions: Thus, ASA did increase bleeding, blood requirements and postoperative rate of pneumonia in CABG on CPB. These results indicate that elective CABG should be delayed until ASA is discontinued for at least 5 days.