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CARDIOVASCULAR ANESTHESIA

The Effect of Perioperative Aspirin Therapy in Peripheral Vascular Surgery: A Decision Analysis

David T. Neilipovitz, FRCPC^*, Gregory L. Bryson, MSc, FRCPC^*, and Graham Nichol, MPH, FRCPC

Departments of *Anesthesiology and Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada; and the Clinical Epidemiology Unit, Loeb Medical Research Institute, Ottawa, Ontario, Canada

Address correspondence and reprint requests to Dr. David T. Neilipovitz, Department of Anesthesiology, The Ottawa Hospital—Civic Campus, 1053 Carling Ave., Ottawa, Ontario K1Y 4E9. Address e-mail to dneilipovitz{at}ottawahospital.on.ca

Patients who undergo infrainguinal revascularization surgery are at increased risk for perioperative thrombotic complications. Aspirin decreases thrombotic events in the nonoperative setting; however, aspirin is often discontinued to avoid perioperative hemorrhagic complications. We used a decision analysis to determine whether aspirin should be discontinued before infrainguinal revascularization surgery. Two strategies were compared: aspirin cessation 2 wk before surgery and aspirin continuation throughout the perioperative period. Clinical events examined included myocardial infarction, thrombotic cerebrovascular accident, hemorrhagic cerebrovascular accident, gastrointestinal hemorrhage, and incisional hemorrhagic complications. Event rates and effect of aspirin were obtained by using MEDLINE. The outcomes were perioperative mortality, life expectancy, and quality-adjusted life expectancy. According to the model, continued aspirin use decreased perioperative mortality rates from 2.78% to 2.05%. Continued aspirin use increased life expectancy from 14.83 to 14.89 yr and increased quality-adjusted life expectancy from 14.72 to 14.79 yr. Aspirin increased the number of hemorrhagic complications by 2.46%, primarily because of an increased incidence of non-life-threatening complications.

IMPLICATIONS: Decision analysis indicates that continued aspirin use in patients undergoing infrainguinal revascularization surgery is associated with a decreased perioperative mortality and increased life expectancy but may increase the likelihood of minor hemorrhagic complications.

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