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Aspirin, also known as acetylsalicylic acid, is mainly used to relieve headaches, toothaches, muscle pain, menstrual cramps, the joint pain from arthritis, and aches associated with colds and flu. (Photo: Magone/Shutterstock)
Jul 5, 2012 | News Americas

Aspirin reduces risk of postoperative kidney failure

by Surgical Tribune

PHILADELPHIA, Pa., USA: Aspirin taken for five days before a heart operation can halve the number of patients who develop postoperative acute kidney failure, researchers from Thomas Jefferson University have found. The results were presented at the European Society of Anaesthesiology congress held recently in Paris.

In a study of 3,219 patients, preoperative aspirin therapy was associated with a reduction in acute renal failure of about three in every 100 patients undergoing coronary artery bypass graft (CABG), valve surgery or both.

The patients were divided into two groups: those taking aspirin within five days before their operation (2,247 patients) and those not taking it (972 patients). Although the researchers had no record of the precise dose taken, between 80 to 325 mg per day is the normal dose for aspirin taken long term.

After adjusting their results for various differing characteristics such as age, disease and other medication, the researchers found that preoperative aspirin was associated with a significant decrease in the incidence of postoperative kidney failure. Acute renal failure occurred in 86 of the 2,247 patients taking aspirin (3.8 percent) and in 65 of the 972 patients not taking it (6.7 percent). This represents an approximate halving in the risk of acute renal failure.

"Thus, the results of this clinical study showed that preoperative therapy with aspirin is associated with preventing about an extra three cases of acute renal failure per 100 patients undergoing CABG or/and valve surgery," said Jianzhong Sun, professor and attending anesthesiologist at Jefferson Medical College, Thomas Jefferson University, in Philadelphia.

Acute renal failure or injury is a common postoperative complication and has a significant impact on the survival of patients undergoing heart surgery. "It significantly increases hospital stay, the incidence of other complications and mortality," said Professor Sun. "From previous reports, up to 30 percent of patients who undergo cardiac surgery develop acute renal failure. In our studies, about 16 to 40 percent of cardiac surgery patients developed it in various degrees, depending upon how their kidneys were functioning before the operation. Despite intensive studies, we don't yet understand why kidney failure can develop after cardiac surgery, but possible mechanisms could involve inflammatory and neurohormonal factors, reduced blood supply, reperfusion injury, kidney toxicity and/or their combinations."

He continued: "For many years, aspirin as an anti-platelet and anti-inflammatory agent has been one of the major medicines in prevention and treatment of cardiovascular disease in nonsurgical settings. Now its applications have spread to surgical fields, including cardiac surgery, and further, to noncardiovascular diseases, such as the prevention of cancer. Looking back and ahead, I believe we can say that aspirin is really a wonder drug, and its wide applications and multiple benefits are truly beyond what we could expect and certainly worthy of further studies both in bench and bedside research."

Sun said that more observational and randomized controlled clinical trials are required to investigate the role of aspirin in preventing postoperative kidney failure, but he believes that the effect might also be seen in patients undergoing noncardiac surgeries.

"For instance, the PeriOperative ISchemic Evaluation-2 trial (POISE-2) is ongoing and aims to test whether small doses of aspirin, given individually for a short period before and after major noncardiac surgeries, could prevent major cardiovascular complications such as heart attacks and death around the time of surgery."

Other findings from Sun's research showed that diabetes, high blood pressure, heart disease, heart failure and diseases of the vascular system are all independent risk factors for postoperative acute kidney failure.

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