Discontinue Aspirin Before Coronary Artery Surgery?

Summary and Comment |
February 24, 2016

Discontinue Aspirin Before Coronary Artery Surgery?

  1. Harlan M. Krumholz, MD, SM

It neither helps nor harms, but continuing the medication might be the wiser choice.

  1. Harlan M. Krumholz, MD, SM

A common question with patients undergoing coronary artery surgery is whether to discontinue aspirin. Inexplicably, we have little evidence to guide our practice. To address this issue, researchers randomized 2100 patients scheduled for surgery and at risk for complications because of age or comorbidities to preoperative aspirin (100 mg) or placebo; treatments were manufacturer-supplied. Patients had not taken aspirin ≥4 days. The study was modified because of low enrollment and was recalculated to have a 96% power to detect a relative difference of 30% in the primary outcome, a composite of death and thrombotic complications within 30 days of surgery.

The primary endpoint occurred in 19% of the aspirin group and 20% of the placebo group, a nonsignificant difference (relative risk, 0.94). There were no significant between-group differences in postoperative myocardial infarction or bleeding.

Comment

Discontinuing aspirin before coronary artery surgery provided neither a benefit nor a harm in this study. The results do not suggest a change in clinicians' current practice, although it may be prudent to continue the aspirin so as not to risk forgetting to restart it.

Editor Disclosures at Time of Publication

  • Disclosures for Harlan M. Krumholz, MD, SM at time of publication Consultant / Advisory board United Healthcare; VHA, Inc.; Premier, Inc. Equity ImageCor; Me2Health Grant / Research support FDA; NIH-NHLBI; Commonwealth Fund; The Catherine and Patrick Weldon Donaghue Medical Research Foundation; Robert Wood Johnson Foundation; Medtronic; Johnson and Johnson; Chinese National Center for Cardiovascular Disease; FDA; CMS Editorial boards BMJ.com/US; American Journal of Managed Care; American Journal of Medicine; Archives of Medical Science; Central European Journal of Medicine; Critical Pathways in Cardiology; Current Cardiovascular Risk Reports; JACC: Cardiovascular Imaging; Journal of Cardiovascular Medicine; Circulation: Cardiovascular Quality and Outcomes Leadership positions in professional societies American Board of Internal Medicine (Chair, Assessment 2020 Task Force)

Citation(s):

Reader Comments (1)

H ROBERT SILVESTEIN Physician, Cardiology, Preventive Medicine Center

This seems a seriously flawed study: the aspirin dose that is used (100 mg = 1/3 of a 325 or 1 and 1/4 of an 81 mg aspirin) is not standard in the USA. An enteric coated aspirin was used when that format is known to dramatically decrease absorption of the aspirin dose, and finally, no aspirin effectiveness test was used to see that the given medicine actually inhibited platelet aggregation. The "science" and ethics of this study are in serious question and call for an investigation, if not retraction. HRS, MD, FACC

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