The Effect of Aspirin as an Irreversible COX1 Inhibitor in Preventing Non-Valvular Atrial Fibrillation After Coronary Bypass Surgery


  • Bilgehan Erkut Atatürk University, Medical Faculty, Department of Cardiovascular Surgery, Erzurum, Turkey
  • Azman Ates Atatürk University, Medical Faculty, Department of Cardiovascular Surgery, Erzurum, Turkey



Background: We investigated whether the use of aspirin (irreversible COX1 inhibitor) in the preoperative period may prevent non-valvular atrial fibrillation, which is the most common rhythm problem in the postoperative period. Non-valvular atrial fibrillation after coronary surgery may lead to an increase in hospital costs due to excessive drug use and long-term hospitalization.

Methods: More than 1000 coronary artery bypass grafting operations were performed between January 2011 to and Nov 2018. The 572 patients were included in this study. Patients were divided into two groups as medication (n=292) and medication-free group (n=280). In the medication group, while patients received aspirin (300 mg daily) therapy (up to 5 days) before the operation, the other group did not receive any anti-aggregan treatment. The patients were followed up for the occurrence of atrial fibrillation from the early postoperative period up to 3 months.

Results: While non-valvular atrial fibrillation was developed in 16 patients (5,5 %) in medication group, this rate was 24,3 % with 68 patients in medication-free group 3 month after operation (P < .05). In addition to the intensive care unit and hospital stay, there was a significant difference between the groups in terms of hospital costs (P < .05).

Conclusions: According to the results of our study, we found that the aspirin used in preoperative period may prevent non-valvular atrial fibrillation in the postoperative period. In relation to these results; we found that hospital stay and hospital expenses decreased.


Balcetyte-Harris N, Tamis JE, Homel P, et al. 2002. Randomized study of early intravenous esmolol versus oral beta-blockers in preventing post-CABG atrial fibrillation in high risk patients identified by signal-averaged ECG: Results of a pilot study. Ann Noninvasive Electrocardiol 7: 86–91.

Chaney MA. 2002. Corticosteroids and cardiopulmonary bypass: a review of clinical investigations. Chest 121:921—31.

Camm AJ, Kirchhof P, Lip GY, et al. 2010. European Heart Rhythm Association; European Association for Cardio- Thoracic Surgery. Guidelines for the management of atrial fibril- lation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31: 2369 –429.

Fuster V, Ryden LE, Cannom DS, et al. 2006. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114: e257–e354.

Gaudino M, Andreotti F, Zamparelli R, et al. 2003. The 174G/C interleukin-6 polymorphism influences postoperative interleukin-6 levels and postoperative atrial fibrillation. Is atrial fibrillation an inflammatory complication? Circulation 108: 195—9.

Goettea A, Lendeckel U. 2004. Nonchannel drug targets in atrial fibrillation. Pharmacol Ther 102: 17—36.

Ho KM, Tan JA. 2009. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation 119: 1853–66.

Imazio M, Brucato A, Ferrazzi P, et al. 2011. Colchicine Reduces Postoperative Atrial Fibrillation: Results of the Colchicine for the Prevention of the Postpericardiotomy Syndrome (COPPS) Atrial Fibrillation Substudy Circulation 124: 2290-95.

Khan MF, Wendel CS, Movahed MR. 2013. Prevention of Post–Coronary Artery Bypass Grafting (CABG) Atrial Fibrillation: Efficacy of Prophylactic Beta-Blockers in the Modern Era. A meta-analysis of latest randomized controlled trials. Ann Noninvasive Electrocardiol 18: 58–68.

Kim YH, Lim DS, Lee JH, et al. 2003. Gene expression profiling of oxidative stress on atrial fibrillation in humans. Exp Mol Med 35: 336 – 49.

Lin PH, Lee SH, Su CP, Wei YH. 2003. Oxidative damage to mitochon- drial DNA in atrial muscle of patients with atrial fibrillation. Free Radic Biol Med 35: 1310 – 8.

Maisel WH, Rawn J, Stevenson WG. 2001. Atrial fibrillation after cardiac surgery. Ann Intern Med 135: 1061–73.

Maniar PB, Balcetyte-Harris N, Tamis JE, et al. 2003. Intravenous versus oral beta-blockers for prevention of post-CABG atrial fibrillation in high-risk patients identified by signalaveraged ECG: Lessons of a pilot study. Card Electrophysiol Rev 7: 158–61.

Mihm MJ, Yu F, Carnes CA, et al. 2001. Impaired myofibrillar energetics and oxi- dative injury during human atrial fibrillation. Circulation 104: 174 –80.

Neuman RB, Bloom HL, Shukrullah I, et al. 2007. Oxidative stress markers are associated with persistent atrial fibrillation. Clin Chem 53: 1652—7.

Ozaydin M, Peker O, Erdogan D, et al. 2008. N-acetylcysteine for the prevention of postoperative atrial fibrillation: a prospective, randomized, placebo-controlled pilot study. European Heart Journal 29: 625–31.

Paparella D, Yau TM, Young E. 2002. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 21:232—44.

Patti G, Chello M, Candura D, et al. 2006. Randomized trial of atorvastatin for reduction of postoperative atrial fibrillation in patients undergoing cardiac surgery: Results of the ARMYDA-3 (Atorvastatin for Reduction of Myocardial Dysrhythmia After cardiac surgery) study. Circulation 114: 1455–61.

Paull DL, Tidwell SL, Guyton SW, et al. 1997. Beta blockade to prevent atrial dysrhythmias following coronary bypass surgery. Am J Surg 173: 419–21.

Ramlawi R, Out H, Mieno S, et al. 2007. Oxidative stress and atrial fibrillation after cardiac surgery: a case-control study. Ann Thorac Surg 84: 1166—73.

Reinhart K, Baker WL, Ley-Wah Siv M. 2011. Beyond the guidelines: new and novel agents for the prevention of atrial fibrillation after cardiothoracic surgery. J Cardiovasc Pharmacol Ther 16: 5–13.

Tomic V, Russwurm S, Moller E, et al. 2005. Transcriptomic and proteomic patterns of systemic inflammation in on-pump and off-pump coronary artery bypass grafting. Circulation 112: 2912–20.

Wijeysundera DN, Beattie WS, Djaiani G, et al. 2005. Off-pump coronary artery surgery for reducing mortality and morbidity: Meta-analysis of randomized and observational studies. J Am Coll Cardiol 46: 872–82.

Villareal RP, Hariharan R, Liu BC, et al. 2004. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 43:742–8.



How to Cite

Erkut, B., & Ates, A. (2019). The Effect of Aspirin as an Irreversible COX1 Inhibitor in Preventing Non-Valvular Atrial Fibrillation After Coronary Bypass Surgery. The Heart Surgery Forum, 22(2), E149-E154.