Stopping aspirin before coronary artery surgery: between the devil and the deep blue sea.

Coronary artery bypass grafting (CABG) aims to reduce immediate and longer-term risks of myocardial infarction and death in patients with coronary artery disease. CABG is, however, associated with its own thrombotic risks of perioperative myocardial infarction, stroke, pulmonary embolism, and bowel infarction.1 These risks are of major concern to the patient and referring cardiologist. Although antiplatelet drugs such as aspirin and clopidogrel can reduce thrombotic events, they might add to a competing risk of excessive bleeding during and after surgery.2,3 Excessive bleeding leads to intraoperative and postoperative hypovolemia and hypotension, delayed completion of surgery, and higher rates of blood transfusion, postoperative tamponade, and reoperation for bleeding.3–6 The bleeding risks most often trouble the cardiac surgeon, and the traditional practice has been to stop aspirin before elective cardiac surgery.