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PERSPECTIVE article

Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1451337
This article is part of the Research Topic Evidence Supporting Surgical Therapies and Emerging Technologies in Cardiovascular Interventional Medicine View all articles

To be or not to be on: Aspirin and Coronary Artery Bypass Graft Surgery

Provisionally accepted
Aashray Gupta Aashray Gupta 1*Joshua Kovoor Joshua Kovoor 1Alasdair Leslie Alasdair Leslie 2Peter Litwin Peter Litwin 2Brandon Stretton Brandon Stretton 1Ammar Zaka Ammar Zaka 3Pramesh Kovoor Pramesh Kovoor 4Stephen Bacchi Stephen Bacchi 1Jayme S. Bennetts Jayme S. Bennetts 5Guy J. Maddern Guy J. Maddern 1
  • 1 University of Adelaide, Adelaide, Australia
  • 2 Royal Adelaide Hospital, Adelaide, South Australia, Australia
  • 3 Gold Coast University Hospital, Southport, Queensland, Australia
  • 4 Westmead Hospital, Westmead, New South Wales, Australia
  • 5 Victorian Heart Institute, Faculty of Medicine, Nursing & Health Sciences, Monash University, Melbourne, Victoria, Australia

The final, formatted version of the article will be published soon.

    Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of reinfarction, the evidence is less definitive for elective CABG procedures. The literature indicates a significant benefit of aspirin in reducing cardiovascular events in CAD patients, yet its impact on perioperative outcomes in CABG surgery is less clear. Some studies suggest increased bleeding risks without substantial improvement in cardiac outcomes. Specific to elective CABG, evidence is mixed, with some data indicating no significant difference in thrombotic or bleeding complications whether aspirin is continued or withheld preoperatively. Advancements in pharmacological therapies and perioperative care have evolved significantly since the initial aspirin trials, raising questions about the contemporary relevance of earlier findings. Individualized patient assessments and the development of risk stratification tools are needed to optimize perioperative aspirin use in CABG surgery. Further research is essential to establish clearer guidelines and improve patient outcomes. The objective of this review is to critically evaluate the existing evidence into the optimal management of perioperative aspirin in elective CABG patients.

    Keywords: Aspirin, coronary artery bypass graft (CABG) surgery, bleeding, Perioperative Care, outcomes

    Received: 19 Jun 2024; Accepted: 31 Jul 2024.

    Copyright: © 2024 Gupta, Kovoor, Leslie, Litwin, Stretton, Zaka, Kovoor, Bacchi, Bennetts and Maddern. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Aashray Gupta, University of Adelaide, Adelaide, Australia

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.