Abstract 4146189: Perioperative Aspirin and Coronary Artery Bypass Graft Surgery: An Updated Meta-Analysis of Randomised Controlled Trials

Background: The decision to continue Aspirin before elective coronary artery bypass graft surgery remains contentious due to competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between CABG patients who stopped and continued aspirin before surgery. Methods: PubMed, MEDLINE and CENTRAL databases were searched from inception to 4 th May 2024 for randomized controlled trials (RCTs) comparing patients undergoing CABG who continued preoperative aspirin with those who discontinued before surgery. Studies with co-intervention arms and multivariable-adjusted or propensity matched observational studies were excluded. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity. Results: Sixteen eligible RCTs were included with a total of 6188 patients. Patients who continued Aspirin demonstrated no significant difference in all-cause mortality [OR 1.37 (0.81-2.33)], perioperative myocardial infarction [OR 0.81 (0.55-1.18)] and postoperative blood loss [mean difference 66.12mL (-1.45-133.69)]. No significant difference was observed between low-dose and higher doses of Aspirin. There was minimal heterogeneity amongst included studies (i 2 = 0%, p=0.97 , i 2 =33%, p=0.13 and i 2 =76, p=0.06 respectively). Studies were of low methodological quality according to Cochrane Risk of Bias for Randomized Trials. Conclusion: This largest to-date systematic review and meta-analysis found no significant difference for risk of all-cause mortality, perioperative myocardial infarction, and postoperative bleeding between patients continuing and stopping Aspirin before CABG.