Discontinue Aspirin before Coronary Artery Surgery?

By Harlan M. Krumholz, MD, SM

Dr. Krumholz is editor-in-chief of NEJM Journal Watch Cardiology, from which this story was adapted. See full coverage at the link below.

Discontinuing aspirin before coronary artery surgery has no effect on high-risk patients, suggests a New England Journal of Medicine study.

Researchers randomized 2100 patients scheduled for coronary surgery and at risk for complications because of age or comorbidities to preoperative aspirin (100 mg) or placebo. Patients either were not taking aspirin before the trial or stopped taking it for at least 4 days before surgery.

The incidence of the primary outcome — a composite of death and thrombotic complications within 30 days of surgery — didn't differ significantly between the aspirin and placebo groups (19% and 20%, respectively). In addition, there were no significant between-group differences in postoperative myocardial infarction or bleeding.

Comment: Discontinuing aspirin before coronary artery surgery provided neither a benefit nor a harm in this study. The results do not suggest a change in clinicians' current practice, although it may be prudent to continue the aspirin so as not to risk forgetting to restart it.