Document Detail


Effects of preoperative aspirin in coronary artery bypass grafting: a double-blind, placebo-controlled, randomized trial.
MedLine Citation:
PMID:  22554721     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: This trial was undertaken to determine the safety and efficacy of preoperative aspirin administration in a contemporary cardiac surgical practice setting.
METHODS: This randomized, double-blind, parallel-group, single-center trial involved patients with stable coronary artery disease who were assigned to receive either 300 mg of aspirin or placebo the night before coronary bypass surgery. Using a random digit table, patients were allocated to receive the tablet from 1 of the 40 coded bottles containing either aspirin or placebo. Patients, surgeons, anesthetists, and investigators were all masked to treatment allocation. The primary safety end points were as follows: more than 750 mL of bleeding during the first postoperative 12 hours and more than 1000 mL of total discharge from the chest drains. The secondary efficacy end point was a composite of cardiovascular death, myocardial infarction, or repeat revascularization.
RESULTS: A total of 390 patients were allocated to aspirin (387 analyzed) and 399 to placebo (396 analyzed). The follow-up median was 53 months. Fifty-four placebo recipients and 86 aspirin recipients bled more than 750 mL in the first 12 hours (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.25-2.63), while total chest drain discharge was above 1000 mL in 96 placebo and 131 aspirin recipients (OR, 1.60; 95% CI, 1.17-2.18). Preoperative aspirin decreased the long-term hazard of nonfatal coronary event (infarction or repeat revascularization)-hazard ratio (HR), 0.58 (95% CI, 0.33-0.99)--and tended to decrease the hazard of a major cardiac event (cardiovascular death, infarction, or repeat revascularization--HR, 0.65 [95% CI, 0.41-1.03]).
CONCLUSIONS: Performing coronary grafts on aspirin is associated with increased postoperative bleeding but may decrease the long-term hazard of coronary events.
Authors:
Marek A Deja; Tomasz Kargul; Wojciech Domaradzki; Tomasz Stącel; Witold Mazur; Wojciech Wojakowski; Radosław Gocoł; Ewa Gaszewska-Żurek; Paweł Żurek; Agata Pytel; Stanisław Woś
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-05-01
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  144     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-19     Completed Date:  2012-09-28     Revised Date:  2012-12-13    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  204-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Second Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. mdeja@sum.edu.pl
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MeSH Terms
Descriptor/Qualifier:
Aged
Aspirin / administration & dosage*
Chi-Square Distribution
Coronary Artery Bypass*
Coronary Artery Disease / surgery*
Double-Blind Method
Female
Follow-Up Studies
Humans
Male
Middle Aged
Placebos
Platelet Aggregation Inhibitors / administration & dosage*
Postoperative Hemorrhage / chemically induced*
Proportional Hazards Models
Treatment Outcome
Chemical
Reg. No./Substance:
0/Placebos; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin
Comments/Corrections
Comment In:
J Thorac Cardiovasc Surg. 2012 Nov;144(5):1274-5; author reply 1275-6   [PMID:  23079015 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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