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12/13/2002

Aspirin Use After Bypass Surgery May Save Lives

Kate Traynor

A large, international study found that aspirin, when given shortly after coronary artery bypass grafting (CABG), greatly improved patients’ chances for survival.

According to the report, administration of up to 650 mg of aspirin within 48 hours after bypass surgery cut postsurgical patient deaths by 68% overall.1 Of 2999 patients who took aspirin in the first 48 hours after surgery, 1.3% died while hospitalized. In contrast, 4.0% of 2023 patients who did not receive aspirin in those first 48 hours died during postsurgical hospitalization. All of the postsurgical deaths among study participants were attributed to an ischemic event in the heart or elsewhere.

Although the 43 patients who died within 48 hours after surgery were excluded from the analysis, the researchers noted that all but two of these deaths occurred among people who had not started early aspirin therapy.

In addition to a reduction in the risk of death, early aspirin use was associated with significant decreases in the occurrence of myocardial infarction, stroke, kidney failure, and bowel infarction—reductions of 48%, 50%, 74%, and 62%, respectively.

Patients who received aspirin within 48 hours after the surgery were less likely than those who did not to suffer a bleeding episode or infection or require surgery to correct a bleeding problem. Early aspirin use also reduced the risk of death among patients receiving perioperative platelet transfusion or antifibrinolytic therapy. The report’s authors noted that these findings call into question the practice of routinely withholding antiplatelet therapy or administering platelets or antifibrinolytic agents in the perisurgical period for fear that patients will bleed excessively.

The observational study involved 5056 patients at 70 medical centers in 17 countries and focused on the 5022 study enrollees who lived for at least 48 hours after scheduled CABG. Study data were collected throughout each patient’s hospital stay.

The decision to use or withhold aspirin was left to each study participant’s physician. According to the report, patient outcomes were not influenced by the dosage of aspirin taken: 75, 81, 100, 150, 162, 250, or 325 mg/day.

The increased survival time and decrease in complications among aspirin users were accompanied by another benefit—a shorter hospital stay. Patients who received early aspirin therapy were hospitalized for 9.5 days on average, compared with 11.5 days for those who did not receive aspirin within 48 hours after surgery.

Because of the study’s design, the findings may not be as convincing to the medical community as they would be if gleaned from a randomized, controlled trial. The report’s authors acknowledged this shortcoming but pointed out that a randomized trial will not likely be conducted to verify the findings.

Despite this limitation of the study, an editorial accompanying the report strongly supported the findings and urged that aspirin use shortly after CABG become standard practice.2 The editorialist, a Cleveland Clinic Foundation physician, noted that the American College of Chest Physicians last year recommended that patients receive aspirin 325 mg/day starting six hours after bypass surgery.

  1. Mangano DT, for the Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med. 2002; 347:1309-17.
  2. Topol EJ. Aspirin with bypass surgery—from taboo to new standard of care. N Engl J Med. 2002; 347:1359-60. Editorial.