Preoperative aspirin therapy and reoperation for bleeding after coronary artery bypass surgery

Article Abstract:

Over a quarter of a million coronary artery bypass graft (CABG) operations are performed each year in the United States, and in about 5 percent of them, a second operation is required to stop excessive bleeding. Many of these patients take aspirin to prevent a heart attack; however, recent use of aspirin increases the risk of rebleeding after bypass surgery. A second operation to stop the bleeding exposes the patient to additional risk from anesthesia, infection, and increased costs. To aid in decision-making in this complex situation, 90 cases of reoperation were matched with 180 subjects who did not require reoperation. Aspirin use prior to surgery almost doubled the probability of reoperation for bleeding, suggesting that aspirin therapy should be stopped whenever possible 7 to 10 days before surgery. Reoperated patients spent an average of 2.6 more days in intensive care and almost four more days in the hospital. Patients requiring reoperation required more blood and blood products, thereby increasing the risk of infection with diseases such as AIDS and hepatitis. Those who underwent reoperation were exposed to an average of almost 26 blood donors, while those not requiring reoperation were exposed to just over six and a half donors on average. Stopping aspirin treatment 7 to 10 days before surgery eliminates the risk of bleeding due to aspirin, but there is an increased risk of heart attack in certain patients who stop taking the aspirin. Intravenous heparin, another anti-clotting drug, is an option because it does not cause bleeding after bypass surgery, but the patient must be hospitalized to receive the heparin. It is concluded that use of aspirin within the seven days before CABG surgery increases the chances of needing a second operation, which is linked to substantially increased need for blood transfusions and longer stays in intensive care and the hospital in general. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Surgery, Postoperative complications, Aspirin, Blood transfusion, Coronary artery bypass, Bleeding

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The coronary stress of skiing at high altitude

Article Abstract:

Skiing may involve a combination of physical exertion, high altitude, and cold air, a combination which can be especially stressful for heart function. To examine the physiologic effects of high-altitude skiing, 149 men were fitted with telemetry electrocardiographs, which relay by radio the heartbeat recordings while the subjects are actually skiing. The majority of the men were over age 40 and regarded themselves as intermediate level skiers, although 20 percent classified themselves as expert. The testing took place at Vail, Colorado, at altitudes between 10,150 feet and 11,250 feet and at temperatures ranging from -1 to -7 degrees centigrade. A total of five men showed evidence of cardiac abnormalities during skiing, which is comparable to the frequency of such findings in men who are engaging in less strenuous exercise at low altitudes. The reason why more subjects did not show evidence of abnormal heart function in these stressful conditions may have been that the men were in very good physical condition. The results indicate that high-altitude skiing does not pose a larger risk of coronary stress among physically fit, older skiers than does similar exercise at normal altitudes in men of average physical fitness. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Abnormalities, Physical fitness, Heart, Sports, Cardiovascular abnormalities, Age groups, Skiing, Skis and skiing, Skis, Age and sports, Silent myocardial ischemia

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The search for the 'Holy Grail' of clinically significant coronary atherosclerosis

Article Abstract:

Canada, Forecasts, trends, outlooks, Care and treatment, Editorial, Forecasts and trends, Diagnosis, Market trend/market analysis, CT imaging, CAT scans, Atherosclerosis

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