The Effect of Aspirin on Bleeding and Transfusion in Contemporary Cardiac Surgery.

Despite evidence that preoperative aspirin improves outcomes in cardiac surgery, recommendations for aspirin use are inconsistent due to aspirin's anti-platelet effect and concern for bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on bleeding and transfusion in cardiac surgery.This retrospective study involved consecutive patients (n=1571) who underwent CABG, valve, or combined CABG and valve surgery at a single center between March 2007 and July 2012. Of all patients, 728 met the inclusion criteria and were divided into two groups: those using (n=603) or not using (n=125) aspirin within 5 days of surgery. Data were collected on chest tube drainage, re-operation for bleeding, and transfusion of red blood cells (RBCs), fresh frozen plasma (FFP), and platelets.No significant difference was observed between the two groups in chest tube drainage or re-operation for bleeding. An increase in patients transfused with RBCs was observed in the aspirin group (61.9 vs 51.2%, adjusted OR 1.77, p=0.027); however, among those transfused RBCs, no significant difference in mean units transfused or massive transfusion was observed. No significant difference was seen in transfusion requirement of FFP or platelets.In patients undergoing CABG, valve, or combined CABG/valve surgery, preoperative aspirin, within 5 days of surgery, was associated with an increased probability of receiving an RBC transfusion. Preoperative aspirin was not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of FFP or platelets

Demographic and Clinical Characteristics.

<p>Values are n (%) for categorical variables and mean±SD for continuous variables.</p><p>Demographic and Clinical Characteristics.</p

Transfusion Outcomes, Aspirin vs No Aspirin.

<p>Values are n (%) or categorical variables and geometric mean, IQR [25, 75] for continuous variables.</p><p>P <0.05 considered significant.</p><p>* Among patients transfused.</p><p>¹Odds Ratio (OR).</p><p>²Geometric Mean Ratio (GMR).</p><p>Transfusion Outcomes, Aspirin vs No Aspirin.</p

Study Inclusion/Exclusion Criteria.

<p>Study Inclusion/Exclusion Criteria.</p

Timing and locations of reef fish spawning off the southeastern United States

<div><p>Managed reef fish in the Atlantic Ocean of the southeastern United States (SEUS) support a multi-billion dollar industry. There is a broad interest in locating and protecting spawning fish from harvest, to enhance productivity and reduce the potential for overfishing. We assessed spatiotemporal cues for spawning for six species from four reef fish families, using data on individual spawning condition collected by over three decades of regional fishery-independent reef fish surveys, combined with a series of predictors derived from bathymetric features. We quantified the size of spawning areas used by reef fish across many years and identified several multispecies spawning locations. We quantitatively identified cues for peak spawning and generated predictive maps for Gray Triggerfish (<i>Balistes capriscus</i>), White Grunt (<i>Haemulon plumierii</i>), Red Snapper (<i>Lutjanus campechanus</i>), Vermilion Snapper (<i>Rhomboplites aurorubens</i>), Black Sea Bass (<i>Centropristis striata</i>), and Scamp (<i>Mycteroperca phenax</i>). For example, Red Snapper peak spawning was predicted in 24.7–29.0°C water prior to the new moon at locations with high curvature in the 24–30 m depth range off northeast Florida during June and July. External validation using scientific and fishery-dependent data collections strongly supported the predictive utility of our models. We identified locations where reconfiguration or expansion of existing marine protected areas would protect spawning reef fish. We recommend increased sampling off southern Florida (south of 27° N), during winter months, and in high-relief, high current habitats to improve our understanding of timing and location of reef fish spawning off the southeastern United States.</p></div

Summary statistics for water depth (m), salinity (ppt), and temperature (°C) during SERFS observations of spawning condition females.

<p>Summary statistics for water depth (m), salinity (ppt), and temperature (°C) during SERFS observations of spawning condition females.</p

Fishery-independent sampling and multispecies spawning locations.

<p>On left, fishery-independent samples of female fish within 48 hours of spawning, by species. Gray shapes denote histological samples, black shapes denote collections of spawning condition females, with triangles denoting chevron traps, diamonds denoting short bottom longline, and circles denoting long bottom longline. On right, sites where females of multiple species have been captured in spawning location at the same time (labeled by collection year). Green boxes denote no-take marine protected areas. Basemap courtesy ESRI and National Park Service.</p

Multi-year observations of spawning.

<p>Sites at which spawning condition females were collected in multiple years (two-digit labels) for Vermilion Snapper (top left), Black Sea Bass (top right), Snowy Grouper (bottom left), and Scamp (bottom right) relative to bathymetry, histological sampling locations (Xs), marine protected areas and SMZs (blue/gray boxes).</p