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Continuing Antiplatelet Therapy Before Cardiac Surgery : A Meta-Analysis

Wednesday, August 28, 2013

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Source Name: Journal of Cardiothoracic and Vascular Anesthesia


Joanne Guay

uay J et al. – The study aims 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. Continuing antiplatelet therapy for patients undergoing surgery with cardiopulmonary bypass (CPB) is associated with a low risk for reexploration.

Methods A meta–analysis of parallel randomized, controlled trials published in English. Patients undergoing surgery with cardiopulmonary bypass (CPB). Continuing antiplatelet therapy versus stopping antiplatelet therapy before the surgery. A search was conducted in PubMed, EMBASE, MEDLINE(R), and the Cochrane Central Register of Controlled Trials. Twelve studies were retained for analysis.

Results 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 30days and 1year, myocardial infarction at 30days, and stroke at 30days. Continuing antiplatelet drugs increases blood loss, SMD 0.27 (95% CI 0.09, 0.45), I–square 73.1%; p=0.003.

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