The Society of Thoracic Surgeons practice guideline series: aspirin and other antiplatelet agents during operative coronary revascularization (executive summary).
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Aspirin↗
Biomedical subjects
Victor A Ferraris
Publications and source records attributed to Victor A Ferraris.
Gender-specific practice guidelines for coronary artery bypass surgery: perioperative management.
Gender differences in coronary bypass surgery have been the focus of numerous publications in recent years. Unfortunately these publications have contradictions that leave surgeons with conflicting recommendations for care. To help resolve these inconsistencies, The Society of Thoracic Surgeons (STS) Workforce on Evidence-Based Surgery has carried out an objective review of published information in this field. The STS Workforce recognizes that there are important gender issues associated with referral bias, the impact of body size, psychosocial factors, and postoperative support, but the intent of this guideline is to focus specifically on perioperative management. As with all practice guidelines, our goal is to gather the most important information, analyze the information in a logical and unbiased fashion, and make recommendations based solely on the available evidence.
Anemia↗
Should coronary artery bypass grafting be regionalized?
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Attitude of Health Personnel↗
Invited commentary.
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Cardiac Surgical Procedures↗
Care of the adult cardiac surgery patient: part I.
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Adult↗
Care of the adult cardiac surgery patient: part II.
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Adult↗
Assessing the medical literature: let the buyer beware.
As many as 30% of journal articles may contain errors. Most of these errors involve the use of simple statistical tests or elementary principles of research design. Assessment of the thoracic surgical literature involves cautious circumspection. This does not mean that it is necessary to have in-depth knowledge of sophisticated statistics, rather it means that common sense understanding of a few principles of research design and simple statistics are necessary to determine the usefulness and believability of literature publications.
Epidemiologic Methods↗
Heroes and evidence.
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Evidence-Based Medicine↗
Aspirin and postoperative bleeding after coronary artery bypass grafting.
OBJECTIVE: To evaluate the relationship between aspirin ingestion and postoperative bleeding complications, and to test the hypothesis that there is a subset of patients who are aspirin hyperresponders with a proclivity toward platelet dysfunction. SUMMARY BACKGROUND DATA: Despite numerous retrospective and prospective analyses, it is still controversial as to whether aspirin ingestion before coronary artery bypass grafting (CABG) is associated with significant postoperative bleeding. METHODS: Between January 1995 and December 1999, the records of 2,606 consecutive patients undergoing CABG were reviewed to identify patients with a history of aspirin ingestion up until the time of surgery. Aspirin ingestion was correlated with postoperative blood transfusion using multivariate analysis. In a subset of preoperative aspirin users (n = 40), bleeding times were measured before and after aspirin use. Flow cytometry was performed in another cohort of patients with known heart disease (n = 30) to determine the effect of aspirin on platelet surface receptors. RESULTS: During the 5-year study period, 63% of the CABG patients were identified as aspirin users. Among these, 23.1% required blood transfusions compared with 19% for the nonusers. Non-red blood cell transfusions were more common in aspirin users, as was reexploration for bleeding. Stratification of these results according to the frequency of aspirin use showed that aspirin is an independent multivariate predictor of postoperative blood transfusion only in high-risk patients. In the prospective studies, aspirin treatment resulted in a significant increase in the template bleeding time, an increase in platelet PAR-1 thrombin receptor activity, and a decrease in the binding of platelets to monocytes. CONCLUSIONS: The findings support the hypothesis that aspirin is associated with a greater likelihood of postoperative bleeding. A platelet function testing algorithm that combines preoperative risk factor assessment, template bleeding times, and flow cytometry may allow the identification of aspirin hyperresponders who are at increased risk for bleeding.
Aspirin↗