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Is Early Aspirin Therapy After CABG Beneficial?
Patients who received aspirin within 48 hours after CABG showed marked reductions in in-hospital mortality and morbidity -- and no increases in bleeding complications.
Aspirin therapy shortly after coronary-artery bypass grafting (CABG) has been controversial because of concerns about postoperative bleeding complications. In this international, prospective, observational study, researchers attempted to determine whether aspirin therapy is beneficial or harmful after CABG.
Of 5022 patients who underwent CABG and still were alive at 48 hours after surgery, 2999 received aspirin within 48 hours after surgery and 2023 did not (aspirin was given at the discretion of treating physicians). Starting at 48 hours, in-hospital mortality was significantly lower among those who received aspirin than among those who did not (1.3% vs. 4%). Nonfatal ischemic complications that involved the heart, brain, kidneys, or gastrointestinal tract also occurred significantly less often in the aspirin group (9.4% vs. 15.4% of patients). In a multivariate analysis adjusted for other potential determinants of postoperative complications, early aspirin use remained strongly associated with reduced mortality (odds ratio for death, 0.41). Surprisingly, rates of bleeding complications were lower in the aspirin group. In contrast to these findings for early aspirin use, first use of aspirin after 48 hours was not associated with reduced in-hospital mortality.
Comment: Aspirin administration during the first 48 hours after CABG was associated with marked reductions in morbidity and mortality. The nonrandomized nature of this study is cause for concern, but the authors and an editorialist argue quite persuasively that the results are not biased. Indeed, the editorialist concludes that, for now, early aspirin use after CABG should become standard practice.
— Allan S. Brett, MD
Published in Journal Watch General Medicine November 5, 2002
Citation(s):
Mangano DT et al. Aspirin and mortality from coronary bypass surgery. N Engl J Med 2002 Oct 24; 347:1309-17.
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Topol EJ. Aspirin with bypass surgery -- From taboo to new standard of care. N Engl J Med 2002 Oct 24; 347:1359-60.
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- Medline abstract (Free)