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Study: Aspirin Benefits Bypass Patients

Finds it does more good than harm in challenge to long-held belief

WEDNESDAY, Oct. 23, 2002 (HealthDayNews) -- A new study on aspirin challenges the long-held belief that the drug should be stopped in patients undergoing cardiac bypass surgery to reduce the risk of excess bleeding.

The latest research, featured in tomorrow's issue of The New England Journal of Medicine, found aspirin therapy should be standard treatment immediately following cardiac surgery because it dramatically decreases the rate of death and complications following the procedure.

"Aspirin [after cardiac bypass surgery] could prevent 9,000 deaths a year and more than 25,000 complications in the U.S.," says Dr. Dennis Mangano, chief executive officer of the Ischemia Research and Education Foundation in San Francisco.

"Aspirin had a very dramatic result, and it's cost-effective and safe," Mangano says.

He adds that aspirin therapy could save as many as 500,000 days of hospitalization and a whopping $1.5 billion. Worldwide, he says that 27,000 lives could be spared and more than 50,000 complications could be avoided by giving aspirin soon after cardiac bypass surgery.

More than 12 million Americans have coronary heart disease, according to the American Heart Association. Coronary bypass surgery is one treatment for the disease and every year in the United States nearly 1 million people have the procedure, the study reports. In bypass surgery, surgeons literally create a detour around a blocked artery. They do this by taking a blood vessel from another part of the body, using it to create a new route for blood to get to the heart.

While this procedure is lifesaving in most cases, 15 percent of patients experience complications that can involve not only the heart but also the brain, the kidneys and even the intestines. Traditionally, little could be done to prevent these complications.

For this study, Mangano collected an extensive amount of data on more than 5,000 patients having cardiac bypass surgery. The patients were from 70 different medical centers in 17 different countries. Some 3,000 patients received varying doses of aspirin -- from 80 milligrams to 650 milligrams -- within 48 hours of their surgery, while the other 2,000 did not.

The results were "striking," says Dr. Eric Topol, chairman of cardiovascular medicine at the Cleveland Clinic Foundation and author of an accompanying editorial.

Patients receiving aspirin therapy had one-third the risk of dying as those who weren't given the drug. The risk of complications was reduced by about 40 percent, according to the study. And aspirin didn't cause more bleeding, Mangano says.

Topol says this study will likely usher in "a sweeping change in treatment after cardiac surgery."

Both Mangano and Topol point out one limitation of the study is that patients weren't randomized, which could lead to a biased result if, for example, only the healthiest patients received aspirin. The researchers did try to control for this factor, and Topol says the results are so dramatic they are still of value.

He also says aspirin may be useful in preventing complications in other types of surgery as well, but it would need to be studied separately before any changes in treatment could be recommended.

Topol says if you're going in for cardiac bypass surgery, be sure to discuss the use of aspirin immediately after surgery with your doctor. Don't, however, initiate aspirin therapy on your own.

What To Do

For more information on the benefits of aspirin, visit Your Family's Health or read this article from the American Heart Association.

SOURCES: Dennis Mangano, M.D., Ph.D., chief executive officer, Ischemia Research and Education Foundation, San Francisco; Eric Topol, M.D., chairman, cardiovascular medicine, Cleveland Clinic Foundation, Cleveland; Oct. 24, 2002, The New England Journal of Medicine
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