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12/15/2011 12:06 AM

Aspirin Before Cardiac Surgery Beneficial

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Aspirin Before Cardiac Surgery Beneficial

By Chris Kaiser, Cardiology Editor, MedPage Today

Published: December 08, 2011

Reviewed by Zalman S. Agus, MD; Emeritus Professor

University of Pennsylvania School of Medicine and

Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

■In guidelines updated in November, the American Heart Association and American College of Cardiology recommended use of preoperative aspirin for patients undergoing CABG.

■This study suggests the preoperative aspirin use in cardiac surgery patients is associated with a significant decrease in the risk of major cardiocerebral complications, renal failure, intensive care unit stay, and 30-day mortality.

Preoperative aspirin therapy was associated with a host of beneficial effects spanning several organ systems, according to a large observational study.

"This study provides new evidence that preoperative aspirin therapy (versus no preoperative aspirin) is associated with a significant decrease in risk of

30 day mortality (3.5% versus 6.5%),

renal failure (3.7% versus 7.1%),

dialysis required (1.9% versus 3.6%),

ICU stay (average 107.2 hours versus 136.1),

and a composite outcome -- MACE (8.7% versus 10.8%); and is not associated with increased risk of readmissions (14.5% versus 12.8%)," Jianzhong Sun, MD, PhD, of Thomas Jefferson University in Philadelphia, and colleagues wrote in Annals of Surgery.

Moreover, aspirin was beneficial even though patients taking preoperative aspirin were significantly older and had more comorbidities than those not taking aspirin.

Taken together, preoperative aspirin seems to have efficacy in the face of the "most important confounding factors -- comorbidities" in these high-risk patients, they said.

Previous studies have found a benefit for early postoperative aspirin therapy after coronary artery bypass graft (CABG) surgery, but evidence supporting the role of preoperative aspirin therapy was less consistent, they said.

The investigators wrote that the Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery recommend discontinuation of aspirin several days prior to cardiac surgery, which also had been the recommendation of the American College of Cardiology (ACC) and the American Heart Association (AHA).

However, in updated guidelines released in November, the ACC and AHA now recommend preoperative aspirin before CABG surgery.

Sun and colleagues analyzed data from 2,868 consecutive patients undergoing CABG, valve surgery, or other cardiac surgery at Thomas Jefferson and UC Davis Medical Center in Sacramento, Calif.

The aspirin group comprised 1,923 patients, while the non-aspirin group consisted of 945 patients.

The major outcomes included 30-day all-cause mortality, postoperative renal failure and/or dialysis required, and a composite outcome of major adverse cardiocerebral events (MACE). MACE included permanent or transient stroke, coma, perioperative MI, heart block, and cardiac arrest. The researchers also looked at readmissions and ICU length of stay.

A total of 1,474 patients underwent CABG, 620 valve surgery, 442 CABG plus valve surgery, and 332 other cardiac surgery.

Overall, the 30-day all-cause mortality rate occurred in 4.5% of patients. In the unadjusted univariate analysis, the breakdown was 3.5% versus 6.5% for those taking and not taking aspirin, respectively (P<0.001).

In the unadjusted analysis, preoperative use of aspirin significantly reduced postoperative renal failure (3.7% versus 7.1%, P<0.001), dialysis required (1.9% versus 3.6%, P=0.007), and ICU stay (107.2 total hours versus 136.1, P<0.001). There was no difference in readmission rates between the two groups.

However, when the researchers adjusted for propensity score and covariates, they found no significant effect of preoperative aspirin on cardiocerebral events that included

permanent stroke, transient ischemic attack, coma, heart block, and cardiac arrest. There was, however, a significant reduction in the risk of MACE, perioperative MI, renal failure, dialysis required, and 30-day mortality.

"The extent and scope of the effect (multiple diverse organs protection) of preoperative aspirin in cardiac surgery patients as showed in this study were unexpected and are most likely a reflection of its anti-inflammatory effect rather than its antithrombotic effect," the authors wrote.

They cautioned that their findings might "overestimate the effect that might be achievable in clinical practice," but noted that similar findings have been reported, most notably from Mangana, et al. (N Engl J Med 2002; 347: 1309–1317).

A small 2005 study by Gerrah, et al. found that aspirin before CABG surgery resulted in shorter ICU stays.

Although further studies are needed, Sun and colleagues suggested that the benefits of preoperative aspirin, particularly low-dose aspirin, may outweigh the risk of bleeding.

The study is limited by potential biases associated with observational studies, researchers said. Also, the data did not indicate dosage or duration of aspirin therapy. However, they said that preoperative use generally means chronic use.

The authors had no relevant disclosures.

From the American Heart Association:

• 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery

Primary source: Annals of Surgery

Source reference:

Cao L, et al "Preoperative aspirin use and outcomes in cardiac surgery patients" Ann Surg 2011; 00: 1–6. utm_content=&utm_medium=email&utm_campaign=DailyHeadlines& utm_source=

© 2011 Everyday Health, Inc. All rights reserved. Sick


10/09/2012 02:48 AM
Posts: 32266
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Aspirin: Protects Brain as Well as Heart[/u

By Nancy Walsh, Staff Writer, MedPage Today

Published: October 05, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Action Points

Low-dose aspirin may help forestall cognitive decline in[u] elderly women at high cardiovascular risk.

Point out that there were no differences between the groups regarding short-term risk for dementia.

Low-dose aspirin may help forestall cognitive decline in elderly women at high cardiovascular risk, Swedish researchers found.

Over a 5-year period, average decline on the + was &#8722;0.05 for women on low-dose aspirin compared with a decline of &#8722;0.95 for non-users, according to Anne Börjesson-Hanson, MD, and colleagues from the University of Gothenburg in Mölndal, Sweden.

And among those specifically at high cardiovascular risk, the decline also was less for aspirin users (&#8722;0.33 versus &#8722;0.95, P=0.028), the researchers reported online in a BMJ Open paper.

While low-dose aspirin has demonstrated benefits in the prevention of cardiovascular disease, studies on aspirin's effects on cognition and dementia have had contradictory findings.

In one double-blind trial, no effects on cognition were seen for aspirin use over 4 years in a cohort of healthy women, but a secondary analysis suggested the possibility of cognitive benefits among those with cardiovascular risks.

To further explore this, Börjesson-Hanson and colleagues conducted interviews and detailed medical and neuropsychiatric examinations for 681 women in 2000.

Mean age was about 75, and the 10-year cardiovascular risk score was 22% according to the Framingham criteria, which defines high risk for a cardiovascular event as 10% or higher.

A total of 95% of the women were at high risk.

Although the American Heart Association recommends the use of low-dose aspirin by individuals at high risk, this is not the current practice in Sweden, and only 18.9% of women at baseline were taking aspirin.

At baseline, the aspirin users had lower MMSE scores and fared worse on word fluency tests.

But when the researchers looked at changes on MMSE for those who were taking aspirin at baseline and continued to do so when seen for follow-up 5 years later, they found an increase in score compared with women who had never been on aspirin (P=0.004).

About 14% of the women also were taking nonsteroidal anti-inflammatory agents (NSAIDs) other than aspirin, which have been reported to contribute to prevention of dementia, but no differences on MMSE scores were seen when NSAID users were compared with non-users.

Other tests of cognitive function such as the naming test and word memory also showed improvements among aspirin users, but the differences were not statistically significant.

There also were no differences between users and nonusers in other relevant outcomes:

Dementia, 8.3% versus 8.4%, P=1.0

Stroke, 7.1% versus 5.2%, P=0.438

Gastric ulcer, 3.6% versus 8.9%, P=0.172

Three women also had hemorrhages during the 5-year follow-up period, none of whom were on aspirin.

The mechanisms by which low-dose aspirin might confer benefits on cognition in the elderly are uncertain, but the researchers hypothesized that the drug's effects may relate to increasing blood flow to the brain through inhibition of platelet aggregation or by increasing the production of neuroprotective molecules known as docosanoids.

The authors concluded that low-dose aspirin appears to be helpful in maintaining cognitive function in elderly women who are at high cardiovascular risk, but noted that longer follow-up will be needed to fully determine the extent of the effect.

They also called for more basic science studies to clarify the specific mechanisms of aspirin in the brain.

Strengths of the study included its population-based, longitudinal design.

Limits included the observational design as well the possibility that confounding by indication may have occurred.

Another shortcoming was the reliance on the MMSE for cognitive assessments, because this test is not the most sensitive for detecting changes in executive functioning -- an area thought to be affected by aspirin.

The study was supported by the Swedish Council for Working Life and Social Research, the Alzheimer's Association Stehanie B. Overstreet Scholars, the Swedish Research Council, the Brank of Sweden Tercentary Foundation, Stiftelsen för Gamla Tjänarinnor and Handlanden Hjalmar Svenssons Forskningsfond.

The authors reported no financial conflicts of interest.

Primary source: BMJ Open

Source reference:

Kern S, et al "Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? a 5-year follow-up of a non-demented population-based cohort of Swedish elderly women" BMJ Open 2012; doi:10.1136/bmjopen-2012-001288. utm_content=&utm_medium=email&utm_campaign=DailyHeadlines& utm_source=

© 2012 MedPage Today, LLC. All rights reserved.


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