Safety And Efficacy Of Continuous Aspirin Use In Elderly Patients Before Off-pump Coronary Artery Bypass Grafting

ObjectiveTo evaluate the safety and efficacy of continuous aspirin use in elderly patients before off-pump coronary artery bypass grafting through retrospective and prospective clinical studies.Methods1.Retrospective clinical study:Data of patients over 65 years old who underwent OPCABG operation in our hospital from November 2016 to November 2017 were collected and divided into two groups according to whether they took aspirin continuously before operation:group A and group B.Statistical methods were used to analyze the number of patients in two groups.According to the analysis.Preoperative data included age,smoking,hypertension,diabetes mellitus,dyslipidemia,history of myocardial infarction and cerebral infarction,history of percutaneous coronary intervention(PCI),preoperative EF(ejection fraction),preoperative BNP(type B natriuretic peptide).Urine peptide,preoperative TNT(troponin T),preoperative HGB(hemoglobin count),preoperative RBC(red blood cell count),preoperative PLT(platelet count);intraoperative data:operation time,number of graft bridges;postoperative data:24 hours after operation citation flow,total postoperative drainage,hospital stay,drainage tube removal,RBC,HGB,PLT,BNP,TNT,blood transfusion,secondary thoracotomy,death and perioperative use of IABP(intra-aortic balloon pump).In addition,6 months and 12 months after discharge of the two groups were followed up,and the follow-up data of the two groups were collected,including frequent angina attacks,acute myocardial infarction,bridge vessel occlusion and cardiogenic death.2.Prospective double-blind randomized controlled clinical study:According to inclusion exclusion criteria,patients over 65 years of age who underwent OPCABG alone in our hospital from April 2019 to July 2019 were screened.All patients included in the analysis were randomly divided into preoperative continuous aspirin group(A1 group)and preoperative discontinuation group(B1 group).The baseline data of aspirin group included age,smoking,hypertension,diabetes,dyslipidemia,history of myocardial infarction and cerebral infarction,history of PCI,perioperative IABP and preoperative EF.BNP,TNT,HGB,RBC,PLT,PT(prothrombin time),INR(international normalized ratio)and APTT(partial thromboplastin time)were examined before and after admission and in the morning after operation respectively TT(thrombin time),PTR(prothrombin time ratio),AA(platelet aggregation)induced by arachidonic acid and TEG(thrombelastography).TEG parameters include:R value(reaction time),K value(kinetics,time of blood clot formation),Angle angle,MA(maximum amplitude)and LY30(lysis at 30 minutes after MA,the percentage of clot dissolution at 30 minutes after MA).Statistical methods were used to analyze the data of two groups of patients.Results1.This retrospective study included 177 patients,74 in group A and 103 in group B.(1)There were no significant differences in preoperative data between the two groups,such as age,smoking,hypertension,diabetes,dyslipidemia,history of myocardial infarction and cerebral infarction,PCI history,preoperative EF,preoperative BNP,preoperative TNT,preoperative PLT,preoperative HGB and preoperative RBC(P>0.05);(2)There were no significant differences in operative time,24-hour drainage,postoperative RBC and postoperative HG between the two groups.(P<0.05);(3)There was statistical difference between the two groups in the extent of red blood cell decline before and after operation and the extent of hemoglobin decline after operation(P<0.05);(4)There were no significant differences in the number of graft bridges,total drainage after operation,the time of drainage tube removal after operation,the time of hospitalization after operation,BNP after operation and TNT after operation in the two groups.There were no significant differences in PLT difference,blood transfusion,second thoracotomy and death between the two groups before and after operation(P>0.05);(5)There were significant differences in IABP implantation between the two groups during the perioperative period(P<0.05);(6)There was no significant difference in blood vessel occlusion and cardiogenic death,frequent angina attacks,acute myocardial infarction and Bridge in the follow-up of 6 months and 12 months after discharge.(P>0.05).2.This prospective study included 144 patients,70 in group A1 and 74 in group B1.(1)The following Age,smoking,hypertension,diabetes mellitus,dyslipidemia,previous myocardial infarction and cerebral infarction,preoperative EF,preoperative BNP,preoperative TNT,preoperative HGB,preoperative RBC,preoperative PLT,preoperative coagulation five items(PT,PTR,INR,TT,APTT),preoperative platelet aggregation rate(AA),preoperative TEG(R,K,Angle angle,etc.)MA and LY30 had no statistical difference(P>0.05);(2)There were statistical differences in operation time,24 hours drainage flow,total drainage flow,RBC and HGB between the two groups(P<0.05);(3)There were statistical differences in erythrocyte and hemoglobin before and after operation between the two groups(P<0.05).(4)There were no significant differences in the number of graft bridges,drainage tube removal time,hospital stay,BNP,TNT,coagulation,blood transfusion,second thoracotomy and death between the two groups(P>0.05);(5)There were significant differences in IABP implantation between the two groups during perioperative period(P<0.05);(6)There were significant differences between the two groups in the platelet aggregation rate(AA)and the R value of TEG(P<0.05),while K value,Angle angle,MA and LY30 were not significantly different(P>0.05).Conclusions1.Continuous use of aspirin before OPC ABG in elderly patients can prolong the operation time,reduce early platelet aggregation rate,increase postoperative bleeding and drainage,but it does not increase blood transfusion,nor does it increase the occurrence of secondary thoracotomy,death and other adverse events2.Continuous use of aspirin before OPCABG in elderly patients can reduce the use of IABP during perioperative period.3.During the recent follow-up,there was no significant difference in frequent angina attack,acute myocardial infarction,bridge vessel occlusion and cardiogenic death between the elderly patients who continued to use aspirin before OPCABG and those who stopped using aspirin.