Association Between Preoperative Aspirin-dosing Strategy and Mortality After Coronary Artery Bypass Graft Surgery. Issue 6 (December 2015)

• Record Type: Journal Article
• Authors: Deng, Yi; Pisklak, Paul V.; Lee, Vei-Vei; Tolpin, Daniel A.; Collard, Charles D.; Elayda, MacArthur A.; Coselli, Joseph; Pan, Wei
• Is Part Of: Annals of surgery. Volume 262:Issue 6(2015:Dec.)
• Publication Date: 2015-12
• Subjects: aspirin -- coronary artery bypass graft -- mortality; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000000951
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To determine whether preoperative aspirin—acetylsalicylic acid (ASA)—timing or dose independently affects 30-day all-cause mortality. Background: Preoperative ASA administration is associated with reduced morbidity and mortality after coronary artery bypass graft (CABG). However, data are lacking regarding optimal timing and dosing of ASA. Methods: We retrospectively reviewed data from 3018 consecutive patients who underwent CABG surgery between July 2005 and May 2011. Patients were assigned to 3 groups according to the time of the last preoperative ASA dose: (1) 24 hours or less preoperatively (n = 1173), (2) between 24 and 72 hours (n = 876), and (3) more than 72 hours or none (n = 969). In a separate analysis, patients were grouped according to ASA dose: 81 mg (n = 1285), 325 mg (n = 1004), and none (n = 543). The primary outcome was 30-day all-cause mortality. Results: The 30-day mortality rate was significantly lower in patients who took ASA 24 hours or less preoperatively (1.5%) than in those who took it between 24 and 72 hours (3.2%) or more than 72 hours or none (2.9%). Multivariate analysis showed that ASA within 24 hours preoperatively was associated with reduced mortality (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.20–0.82; P = 0.01). Moreover, mortality was significantly reduced for patients taking 81 mg of ASA (1.4%) compared with 325 mg (2.9%) or none (3.9%). Multivariate analysis demonstrated that 81 mg of ASA decreased mortality risk by 66% (OR, 0.34; 95% CI, 0.18–0.66; P < 0.01), whereas 325 mg of ASA had no mortality benefit (OR, 0.74; 95% CI, 0.41–1.35; P = 0.33) compared with no ASA. Conclusions: Low-dose ASA use within 24 hours of CABG is independently associated with decreased early postoperative mortality.