Medical therapy to prevent complications after coronary artery bypass graft surgery
- Sary Aranki, MD
Sary Aranki, MD
- Associate Professor of Surgery
- Harvard Medical School
- Julian M Aroesty, MD
Julian M Aroesty, MD
- Clinical Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Gabriel S Aldea, MD
Gabriel S Aldea, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington
- Edward Verrier, MD
Edward Verrier, MD
- Section Editor — Cardiac Surgery
- Professor of Surgery
- University of Washington School of Medicine
- Guy S Reeder, MD
Guy S Reeder, MD
- Section Editor — Coronary Disease
- Professor of Medicine
- Mayo Medical School
The treatment of coronary heart disease (CHD) has evolved significantly over the past several years due in part to improvement in both surgical and percutaneous revascularization techniques. The majority of patients with chronic stable angina are still treated with medical therapy; however, revascularization with either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) should be considered in several subgroups. (See "Stable ischemic heart disease: Indications for revascularization".)
The medical therapies that can minimize the short-term, particularly perioperative complications that can occur following conventional CABG (using cardiopulmonary bypass) will be reviewed here. A general discussion of the early complications of CABG is presented separately. (See "Early noncardiac complications of coronary artery bypass graft surgery".)
Aspirin should be administered to all patients without a contraindication who have cardiovascular disease. (See "Aspirin for the secondary prevention of atherosclerotic cardiovascular disease", section on 'Summary and recommendations'.)
With respect to efficacy in patients undergoing coronary artery bypass graft surgery (CABG), a systematic review from the Antiplatelet Trialists' Collaboration concluded that antiplatelet therapy, particularly if given early, was associated with improved graft patency at an average of one year after surgery (pooled odds reduction for graft closure of 44 percent) . This benefit was similar with low-dose aspirin (75 to 325 mg/day) as with higher and more gastrotoxic doses. Antacids and proton pump inhibitors are commonly given in the perioperative period to further attenuate this risk.
Preoperative aspirin — All patients with cardiovascular disease (CVD) should receive lifelong aspirin to prevent ischemic cardiovascular events. Thus, most patients referred for CABG take aspirin daily and we continue aspirin until surgery. For patients with a new diagnosis of CVD (and not taking aspirin) and who need CABG, the decision to start aspirin preoperatively should be individualized, taking into account the duration of the delay to surgery (ie, risk of an ischemic event in the interval between diagnosis and CABG), the bleeding risk at the time of surgery, and potential problems associated with starting a new medication shortly before surgery. If the delay is more than five days, we start aspirin in most cases. If the delay is less than five days, most of our experts start aspirin in patients not at high bleeding risk.
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- Preoperative aspirin
- Postoperative aspirin
- Aspirin summary
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