Mayo Clinic Study: Don't Stop Aspirin Before Heart Surgery ?

[DuchessBear]

This study by the Mayo Clinic indicates that continuing to take aspirin before heart surgery might actually improve your odds of survival.

Mayo Clinic study: Don't stop taking aspirin before heart surgery

Aspirin use associated with lower mortality, but doesn't raise bleeding risk.

"Aspirin reduces clotting of the blood, so it can help prevent a heart attack or stroke by making it less likely a clot will form and block an already narrowed artery," explains R. Scott Wright, M.D., the Mayo Clinic cardiologist who led the study. "However, many surgeons who are concerned about excessive bleeding due to inadequate clotting have advised their patients to stop taking aspirin in the days before their operation. We designed this study to provide guidance on whether continuing aspirin therapy in the days before surgery is beneficial or risky."

The researchers collected data from 1,636 patients who had first-time coronary artery bypass surgery at Mayo Clinic in 2000, 2001 and 2002. Patients were divided into two groups: those who had taken aspirin within the five days before surgery (1,316 patients), and those who had not (320). Characteristics of the two groups were similar, except patients in the aspirin group were more likely to have had a previous heart attack, while those not taking aspirin were more likely to be on dialysis. All members of both groups received aspirin therapy following surgery, starting six hours after their operation.

Results

The in-hospital mortality for the aspirin group (1.7 percent) was significantly less than that for those not receiving aspirin (4.4 percent), and there was no increased risk of reoperation for excessive internal bleeding.

The study results suggest a reduction in strokes and related events, but the trend was not strong enough to be statistically significant.

"This is a very strong association of survival with taking aspirin in the days leading up to surgery," says Dr. Wright. "The study further confirms aspirin's benefits for patients with known cardiovascular disease. It also shows there is no increased risk of bleeding, which eliminates the main reason why physicians and surgeons would ask patients to discontinue aspirin therapy. Patients with heart disease who are not taking aspirin should ask themselves -- and their doctors -- 'Why not?'"

###
The findings are published this week in Circulation: Journal of the American Heart Association. Other co-authors include Kevin Bybee, M.D., Brian Powell, M.D., Uma Valeti, M.D., A. Gabriela Rosales, M.S., Stephen Kopecky, M.D., and Charles Mullany, M.B. M.S.

The study was funded by Mayo Clinic's Division of Cardiovascular Diseases. Dr. Wright has previously received research grant support from Bayer Pharmaceuticals.

 

[lance]

Aspirin and surgery in general

Aspirin and surgery in general

Very interesting results about aspirin and heart surgery sponsored by Bayer--a manufacturer of aspirin.

One wonders if the results had favoured the discontinuance of aspirin as being more favourable to heart surgery outcomes if the paper would have been written--just my suspicious nature.

I also wonder if continuing aspirin therapy prior non-heart surgeries is beneficial to patients or even if it is known.

What do you think?

 

[Guest]

If there had been negative results it would probably not have been published but it may have had nothing to do with the sponsor. Mayo Clinic is powerful enough to not have to bend to the demands of a drug manufacturer. Also the economic benefit or harm to Bayer would be small since they are a large multinational company.

I think that the reason that it would not have been published would be that the journal editors want to fill their pages with interesting stuff - not things that produce a yawn and a so what. Probably well less than half of the studies submitted for publication get published because they are yawners.

 

[gijanet]

Interesting.............

Interesting.............

Katie has been on aspirin therapy since she was a month old. We have always stopped her aspirin ten days out from surgery - yes, for all three subsequent surgeries. While we have had numerous complications post-op, they have never been clot-related. Might have to share this with Katie's surgeon and get his take on this as many, many of the CHD kids are on aspirin. Katie, by the way, is still on aspirin now as well as the coumadin.

Thanks for posting this. J.

 

[lance]

The yawn factor, hehehe

The yawn factor, hehehe

Yah, the yawn factor--no one would read it anyway.

Good point

If there had been negative results it would probably not have been published but it may have had nothing to do with the sponsor. Mayo Clinic is powerful enough to not have to bend to the demands of a drug manufacturer. Also the economic benefit or harm to Bayer would be small since they are a large multinational company.

I think that the reason that it would not have been published would be that the journal editors want to fill their pages with interesting stuff - not things that produce a yawn and a so what. Probably well less than half of the studies submitted for publication get published because they are yawners.

 

[DuchessBear]

Here's a related study that indicates that you should not stop aspirin therapy "cold turkey".


Suddenly stopping routine use of aspirin could be dangerous.

THE QUESTION Many people take aspirin not for its painkilling attributes but to thin their blood, keeping it from forming clots that can lead to a heart attack or stroke. Sometimes people stop taking aspirin before surgery, to avoid bleeding problems; sometimes they quit for no apparent reason. Is there any danger in stopping?

THIS STUDY compared 309 aspirin-takers who had a stroke or transient ischemic attack (commonly called a mini-stroke) with 309 similar people who had not had strokes and were taking the drug as a preventative. The participants, who were mostly men, took about 200 milligrams daily. In the stroke group, 13 people had stopped taking aspirin four weeks or less before their stroke, compared with four people in the other group who had stopped taking it within four weeks or less of being interviewed for the study. The researchers calculated that a sudden stop triples one's risk of stroke compared with continuing to take aspirin regularly. The authors suggest that stopping aspirin therapy before surgery may not always be advisable in people with cardiovascular risk factors.

WHO MAY BE AFFECTED BY THESE FINDINGS? People who take aspirin daily to stave off cardiovascular problems.

CAVEATS The findings were based on a small number of people who stopped taking aspirin.

FIND THIS STUDY August issue of the Archives of Neurology; abstract available online at http://www.archneurol.com .