Continuing Antiplatelet Therapy Before Cardiac Surgery With Cardiopulmonary Bypass: A Meta-Analysis on the Need for Reexploration and Major Outcomes

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 28; no. 1; pp. 90 - 97
• Main Authors: Guay, Joanne, MD, Andrew Ochroch, E., MD, MSCE
• Format: Journal Article
• Language: English
• Published: United States 01.02.2014
• Subjects: Anesthesia & Perioperative Care; Blood Loss, Surgical; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Coronary Artery Bypass; Critical Care; Humans; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Reoperation; Treatment Outcome; red blood cells; fresh frozen plasma; death; blood loss; antiplatelets; myocardial infarction; cardiopulmonary bypass; cardiac surgery; stroke; platelets; reexploration
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.03.013

Objective To determine major adverse outcomes, including the risk of mediastinal reexploration, death, stroke and myocardial infarction, associated with continuing antiplatelet therapy in patients undergoing surgery with cardiopulmonary bypass. Design A meta-analysis of parallel randomized, controlled trials published in English. Setting A university-based electronic search. Participants Patients undergoing surgery with cardiopulmonary bypass (CPB). Intervention Continuing antiplatelet therapy versus stopping antiplatelet therapy before the surgery. Measurements and Main Results A search was conducted in PubMed, EMBASE, MEDLINE(R), and the Cochrane Central Register of Controlled Trials. Twelve studies were retained for analysis. Continuing antiplatelet drugs for CPB increases the rate of reexploration by a standardized mean difference (SMD) 0.22, 95% confidence interval (CI) 0.06, 0.39; I-square 0%; p value 0.01; classical fail-safe number 5. The number needed to harm (NNTH) is 87 (95% CI 390, 44). There was no statistical difference for death at 30 days and 1 year, myocardial infarction at 30 days, and stroke at 30 days. Continuing antiplatelet drugs increases blood loss, SMD 0.27 (95% CI 0.09, 0.45), I-square 73.1%; p = 0.003. Conclusions Continuing antiplatelet therapy for patients undergoing surgery with CPB is associated with a low risk for reexploration.