This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Van Rensburg, A. Articles by Beattie, S. Search for Related Content PubMed Articles by Van Rensburg, A. Articles by Beattie, S.

26475 - WITHDRAWAL OF ASPIRIN INCREASES THE RISK OF PERI-OPERATIVE

Toronto General Hospital, UHN, Toronto, ONTARIO, Canada

BACKGROUND: The antiplatelet effects of aspirin have shown a decrease in vascular death by 15% and nonfatal vascular events by 30%.(1) Recent publications suggest that there might be an association between peri-operative coagulation activation, post-operative hypercoagulability and peri-operative myocardial infarction. (2,3). These results might suggest a possible protective effect of aspirin in the peri-operative period.

METHODS: Following REB approval, data were prospectively collected on 2996 consecutive patients who underwent non-cardiac, non-day surgery for a 15-month period at Toronto General Hospital. The relationship between cardiac risk factors (history of CAD, CHF, CVA, elevated Creatinine, diabetes) anemia, blood transfusion, Calcium channel blockers, statins ACE inhibitors, epidural analgesia, aspirin and myocardial infarction were analyzed using descriptive statistics and logistic regression. Patients who were taking aspirin were divided into 2 groups.

Group 1 - stopped aspirin 7 days pre-operative and Group 2 continued aspirin through the peri-operative period. Diagnosis of myocardial infarction was made by a independent and blinded cardiologist based on tropinin I level greater than 0.70ng/m which correlated with EGG changes, clinical symptoms and new wall motion abnormalities on echocardiography during the hospitalization period.

RESULTS: Cardiac risk factors (history of CHF, high risk surgery, history of CAD) age, gender, pre operative anemia, blood transfusion, lipid lowering therapy and aspirin had significant associations with peri-operative MI. Independently associated factors for peri-operative MI in multiple logistic regression analysis were age (OR 1.75 95% CI 1.13–2.71), gender (OR 1.76 95% CI 1.10–2.81), history of coronary artery disease (OR 2.67 95% CI 1.57–4.53), CHF (OR 3.89 95% CI 1.639.28), High risk surgery (OR .58 95% CI 1.01–2.47) any transfusion of red blood cells (OR 2.51 95% CI 1.52–4.13) and withdrawal of aspirin within 7 days of surgery (OR 2.51 95% CI 1.37–4.66).

CONCLUSIONS: In this study aspirin withdrawal 7 days prior to surgery was identified as an independent risk factor associated with peri-operative MI. Whether the mechanism is inhibition of coagulation activation or prevention of hyper coagulation will need to determined in future prospective studies together with the effect on peri-operative bleeding.

1 BMJ 2002; 324:71–86[Abstract/Free Full Text]

2 Anaesthesia 2005, 60, pages 1162–1167[Medline]

3 Anesth Analg 2005; 100:1576–83[Abstract/Free Full Text]

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Van Rensburg, A. Articles by Beattie, S. Search for Related Content PubMed Articles by Van Rensburg, A. Articles by Beattie, S.