Perioperative aspirin and coronary artery bypass graft surgery: An updated meta-analysis of randomized controlled trials

Aashray K Gupta; Ammar Zaka; Alexander Lombardo; James Tsimiklis; Brandon Stretton; Joshua G Kovoor; Stephen Bacchi; Fabio Ramponi; Justin C Y Chan; Aravinda Thiagalingam; Paul Gould; Gopal Sivagangabalan; Sarah Zaman; Clara Chow; Pramesh Kovoor; Julian A Smith; Jayme S Bennetts; Guy J Maddern

doi:10.1016/j.surg.2024.109003

Perioperative aspirin and coronary artery bypass graft surgery: An updated meta-analysis of randomized controlled trials

Surgery. 2024 Dec 20:180:109003. doi: 10.1016/j.surg.2024.109003. Online ahead of print.

Authors

Aashray K Gupta¹, Ammar Zaka², Alexander Lombardo³, James Tsimiklis⁴, Brandon Stretton⁴, Joshua G Kovoor⁴, Stephen Bacchi⁴, Fabio Ramponi⁵, Justin C Y Chan⁶, Aravinda Thiagalingam⁷, Paul Gould⁷, Gopal Sivagangabalan⁷, Sarah Zaman⁷, Clara Chow⁷, Pramesh Kovoor⁷, Julian A Smith⁸, Jayme S Bennetts⁹, Guy J Maddern¹⁰

Affiliations

¹ Discipline of Surgery, University of Adelaide, Adelaide, Australia. Electronic address: aashray.gupta@adelaide.edu.au.
² Gold Coast University Hospital, Southport, Australia.
³ Princess Alexandra Hospital, Brisbane, Australia.
⁴ Discipline of Surgery, University of Adelaide, Adelaide, Australia.
⁵ Yale University, New Haven, CT.
⁶ New York University, New York, NY.
⁷ Westmead Hospital, Westmead, Australia.
⁸ Department of Cardiothoracic Surgery, Victorian Heart Hospital, Melbourne, Australia.
⁹ School of Medicine, Monash University, Melbourne, Australia; Department of Cardiothoracic Surgery, Victorian Heart Hospital, Melbourne, Australia.
¹⁰ Discipline of Surgery, University of Adelaide, Adelaide, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, Australia; Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, Australia.

PMID: 39708413
DOI: 10.1016/j.surg.2024.109003

Abstract

Background: The decision to continue aspirin before elective coronary artery bypass graft surgery remains contentious because of competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between patients undergoing coronary artery bypass grafting who stopped and continued aspirin before surgery.

Methods: PubMed, MEDLINE, and CENTRAL databases were searched from inception to 4 October 2023 for randomized controlled trials comparing patients undergoing coronary artery bypass grafting who continued preoperative aspirin with those who discontinued before surgery. Studies with cointervention arms and multivariable-adjusted or propensity matched observational studies were excluded. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity.

Results: Fifteen eligible randomized controlled trials were included with a total of 6,188 patients. Patients who continued aspirin demonstrated no significant difference in all-cause mortality (odds ratio, 1.37; confidence interval, 0.81-2.33), perioperative myocardial infarction (odds ratio, 0.81; confidence interval, 0.55-1.18), and postoperative blood loss (mean difference, 66.12 mL; confidence interval, -1.45 to 133.69). No significant difference was observed between low-dose and greater doses of aspirin. There was minimal heterogeneity amongst included studies (I² = 0%, P = .97, I² = 33%, P = .13, and I²= 76, P = .06, respectively). Studies were of low methodologic quality according to Cochrane Risk of Bias for Randomized Trials.

Conclusions: This largest to-date systematic review and meta-analysis found no significant difference for risk of all-cause mortality, perioperative myocardial infarction, and postoperative bleeding between patients continuing and stopping aspirin before coronary artery bypass grafting.

Publication types

Review