Stopping versus continuing acetylsalicylic acid before coronary artery bypass surgery: A systematic review and meta-analysis of 14 randomized controlled trials with 4499 patients.

Autor:	Sá MPBO; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences, Biological Sciences Instituite (FCM/ICB), Recife, Brazil., Soares AF; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil., Miranda RGA; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil., Araújo ML; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil., Menezes AM; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil., Silva FPV; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil., Lima RC; Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Brazil.; University of Pernambuco (UPE), Recife, Brazil.; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences, Biological Sciences Instituite (FCM/ICB), Recife, Brazil.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2017 Nov 01; Vol. 52 (5), pp. 838-847.
DOI:	10.1093/ejcts/ezx293
Abstrakt:	This study aimed to evaluate the efficacy and safety of continuing versus stopping aspirin [acetylsalicylic acid (ASA)] preoperatively in patients undergoing coronary artery bypass graft surgery. MEDLINE, EMBASE, CENTRAL/Cochrane Controlled Trials Register (CCTR), ClinicalTrials.gov, Scientific Electronic Library Online (SciELO), Literatura Latino Americana em Ciências da Saúde (LILACS), Google Scholar and reference lists of relevant articles were searched for randomized controlled trials that reported efficacy outcomes of myocardial infarction and mortality, and safety outcomes of blood loss, packed red blood cell transfusion and surgical re-exploration were compared between groups. Fourteen studies fulfilled our eligibility criteria and included a total of 4499 patients (2329 for 'continuing ASA' and 2170 for 'stopping ASA'). In the pooled analysis, continuing aspirin therapy did not reduce the risk of myocardial infarction [risk ratio 0.834, 95% confidence interval (CI) 0.688-1.010; P = 0.063] or operative mortality (risk ratio 1.384, 95% CI 0.727-2.636; P = 0.323). Preoperative ASA increased postoperative chest tube drainage (mean difference 143 ml, 95% CI 39-248 ml; P = 0.007) and packed red blood cell transfusion (mean difference 142 ml, 95% CI 55-228; P = 0.001) but did not increase the risk of surgical re-exploration (risk ratio 1.316, 95% CI 0.910-1.905; P = 0.145). This meta-analysis found no statistically significant difference regarding the risk of operative mortality and myocardial infarction between the 'continuing ASA' and 'stopping ASA' strategies. On the other hand, the mean volume of blood loss and packed red blood cell transfusion was higher in the 'continuing ASA' group, but this finding did not translate into higher risk of reoperation for bleeding. (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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