Effect of timing of chronic preoperative XXXX discontinuation on morbidity and mortality in coronary artery bypass surgery.

@entity1 @entity64 @entity548 @entity63 @entity117 @entity86 @entity583 @entity1281
BACKGROUND: @entity117 (ASA) has been shown to reduce postoperative coronary artery bypass grafting (CABG) mortality and @entity63 events; however, the timing of chronic ASA discontinuation before surgery is controversial because of concern about @entity86 . We evaluated the effect of the timing of ASA discontinuation before CABG on major adverse cardiovascular outcomes and @entity86 using the Cleveland Clinic Cardiovascular Information Registry database. METHODS AND RESULTS: At the Cleveland Clinic between January 1, 2002, and January 31, 2008, 4143 @entity1 undergoing CABG were taking preoperative chronic ASA. Of these, 2298 discontinued ASA 6 or more days before surgery (early discontinuation), and 1845 took ASA within 5 days of the surgery (late use). Because of substantial differences between these 2 groups, propensity score analysis, and matching based on 31 variables were used for fair comparison of outcomes. This resulted in 1519 well-matched pairs of @entity1 (73%). There was no significant difference between those with early discontinuation and late ASA use with regard to the composite outcome of in-hospital mortality, @entity583 , and @entity64 (1.7% versus 1.8%, P=0.80). Late use was associated with more intraoperative transfusions (23% versus 20%, P=0.03) and postoperative transfusions (30% versus 26%, P=0.009) but a similar number of reoperations for @entity548 (3.4% versus 2.4% P=0.10). CONCLUSIONS: Among @entity1 undergoing isolated CABG, late discontinuation of @entity1281 resulted in no difference in postoperative cardiovascular outcomes; however, there was an increased transfusion requirement. Thus, we recommend weighing the risks and benefits of late ASA use in these @entity1 .
