Continuation Of Aspirin Therapy Research Articles

COMPARISON OF OUTCOME WITH OR WITHOUT ASPIRIN IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY

Preoperative use of aspirin in coronary artery bypass graft surgery (CABG) might rely more on surgeon’s preference rather than on evidence-based approach. Conflicting guidelines and lack of reliable recommendations make ambiguous the preoperative aspirin administration before elective CABG. This study was conducted to compare the outcome with or without aspirin in patients undergoing coronary artery bypass surgery. The aim of the study was to compare the outcome with or without aspirin in patients undergoing coronary artery bypass surgery. This Randomized controlled trial was conducted at the Department of Cardiac Surgery, AFIC/ NIHD, Rawalpindi from 11th Dec 2018 to 10th June 2019. One hundred and fifty patients fulfilling inclusion criteria underwent through CABG were divided into two groups. In group A, 75 patients continued aspirin, while in group B, aspirin was stopped 5 days before surgery. Patient’s demographic features, comorbid conditions, Postoperative bleeding, perioperative MI and need for blood transfusion were noted. The mean age and BMI of patients were 61.41 ± 3.09 and 63.96 ± 7.64 years and 28.98 ± 2.46 and 32.61 ± 1.98 Kg/m2 in group A and B, respectively. Male to female ratios were 3.41:1 and 4.35:1 in group A and B, respectively. Diabetes and hypertension were seen in 67(89.34%) and 59(78.67%) patients and 69(90.67%) and 70(93.34%) patients in group A and B, respectively. Perioperative MI and blood transfusion were statistically significant among both groups (5.34% vs. 9.34% patients; p=0.0001 and 5.34% vs. 1.34%; p=0.0003). Mean postoperative bleeding was 401.39 ± 121.04 and 389.21 ± 101.13 ml/24 hr. in group A and B, respectively. The continuation of aspirin therapy in patients undergoing elective CABG reduces perioperative MI, increases quantity of postoperative bleeding and need for blood transfusion. There is a significant difference in outcome with or without aspirin in patients undergoing coronary artery bypass surgery.

Continuation of Aspirin Therapy before Cataract Surgery with Different Incisions: Safe or Not?

Purpose To assess whether to continue aspirin therapy while having uncomplicated phacoemulsification cataract surgery with different incisions. Methods Consecutive patients having cataract surgery under topical anesthesia with different incisions between May 2016 and August 2017 were followed. 236 eyes of 166 patients on routine aspirin therapy were randomized into 2 groups: continuation group, 112 eyes; discontinuation group, 124 eyes. 121 eyes of 94 patients on no routine anticoagulant therapy were used as the control group. Patients were examined 1 day preoperatively and 1 day and 7 days postoperatively. Intraoperative and postoperative complications were recorded. Results Statistically, there was no significant difference about postoperative BCVA among three groups. A higher incidence of subconjunctival hemorrhage was shown in the continuation group than in the discontinuation group and the control group (17.0% versus 8.1%, p=0.038; 17.0% versus 7.4%, p=0.025, resp.). Although corneal edema was greater in clear corneal incision cases than that of scleral tunnel incision cases (22.5% versus 12.0%, p=0.009), subconjunctival hemorrhage was greater in scleral tunnel incision cases (14.9% versus 6.6%, p=0.011). Subgroup analyses revealed that patients of scleral tunnel incision who continued taking aspirin had a higher incidence of subconjunctival hemorrhage compared with those who discontinued (25.5% versus 10.9%, p=0.038), but no same conclusion in clear corneal incision cases (8.8% versus 5.0%, p=0.483). Conclusions The outcomes indicated that phacoemulsification cataract surgery under topical anesthesia could be safely performed without ceasing systemic aspirin therapy. Clear corneal incision could be a better choice in patients treated with aspirin.

Management of Antiplatelet Therapy inPatients at Risk for Coronary StentThrombosis Undergoing Non-Cardiac Surgery

Percutaneous coronary interventions (PCIs) have become the most commonly performed coronary revascularization procedures. At the same time, there is an increased likelihood that patients with intracoronary stents will need to undergo surgery. Two serious consequences emerge from this situation: (i) stent thrombosis in relation to discontinuation of antiplatelet therapy, and (ii) major bleeding in relation to continuation of antiplatelet therapy. The best solution to overcome the risks resulting from surgery performed in patients after stent implantation is to postpone the operation until after re-endothelialization of the vessel surface is completed. Expert recommendations advise that patients can be sent for non-cardiac surgery 3 months after bare-metal stent PCI and 12 months after drug-eluting stent PCI, with continuation of aspirin therapy. Difficult decisions regarding antiplatelet management arise when a patient that is still receiving dual antiplatelet therapy with aspirin and a thienopyridine has to undergo surgery that cannot be postponed. Discussions between the treating cardiologist, the surgeon and the anaesthesiologist about this situation are recommended in order to achieve a reasonable expert consensus.