Effect of Clopidogrel on Midterm Graft Patency following Off-Pump Coronary Revascularization Surgery

Ibrahim, Khalid S.; Tjomsland, Ole; Halvorsen, D. K.; Wiseth, Rune; Wahba, Alexander; Karevold, Asbjørn; Haaverstad, Rune

doi:10.1532/hsf98.20061034

Cited by 28 publications

(26 citation statements)

References 19 publications

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“…Major bleeding after surgery was more frequent with DAPT . 122,123,135 The benefits of DAPT in off-pump CABG patients were noted in terms of improved graft patency 124,125 and clinical outcome 136 in single-center observational studies 124,136 and an RCT 125 (Data Supplement 10) . Only data from post hoc analyses are available on the utility of newer P2Y 12 inhibitors in patients with ACS who undergo CABG .…”

Section: C-eomentioning

confidence: 99%

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Di

et al. 2016

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Section: C-eomentioning

confidence: 99%

2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Di

et al. 2016

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“…12,25 Although prospective randomized controlled trial data have been lacking in the field, 12 previous observational studies in the cardiac surgery literature have suggested that clopidogrel may improve postoperative outcomes. [25][26][27] In a case series of off-pump CABG patients, Ibrahim et al 26 demonstrated that the addition of clopidogrel to aspirin was associated with a trend toward improved SVG patency 6 months after surgery. Similarly, in an observational study, Gurbuz et al 27 noted that postoperative clopidogrel was associated with less symptom recurrence and fewer adverse cardiac events.…”

Section: Discussionmentioning

confidence: 99%

Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting

et al. 2010

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Background-Clopidogrel inhibits intimal hyperplasia in animal studies and therefore may reduce saphenous vein graft (SVG) intimal hyperplasia after coronary artery bypass grafting. The Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) study was undertaken to evaluate whether the addition of clopidogrel to aspirin inhibits SVG disease after coronary artery bypass grafting, as assessed at 1 year by intravascular ultrasound. Methods and Results-In this double-blind phase II trial, 113 patients undergoing coronary artery bypass grafting with SVGs were randomized to receive aspirin 162 mg plus clopidogrel 75 mg daily or aspirin 162 mg plus placebo daily for 1 year. The primary outcome was SVG intimal hyperplasia (mean intimal area) as determined by intravascular ultrasound at 1 year. Secondary outcomes were graft patency, major adverse cardiovascular events, and major bleeding. One-year intravascular ultrasound and coronary angiography were performed in 92 patients (81.4%). At 1 year, SVG intimal area did not differ significantly between the 2 groups (4.1Ϯ2.0 versus 4.5Ϯ2.1 mm 2 , aspirinclopidogrel versus aspirin-placebo, Pϭ0.44). Overall 1-year graft patency was 95.2% in the aspirin-clopidogrel group compared with 95.5% in the aspirin-placebo group (Pϭ0.90), and SVG patency was 94.3% in the aspirin-clopidogrel group versus 93.2% in the aspirin-placebo group (Pϭ0.69). Freedom from major adverse cardiovascular events at 1 year was 92.9Ϯ3.4% in the aspirin-clopidogrel group and 91.1Ϯ3.8% in the aspirin-placebo group (Pϭ0.76). The incidence of major bleeding at 1 year was similar for the 2 groups (1.8% versus 0%, aspirin-clopidogrel versus aspirin-placebo, Pϭ0.50). Conclusions-Compared with aspirin monotherapy, the combination of aspirin plus clopidogrel did not significantly reduce the process of SVG intimal hyperplasia 1 year after coronary artery bypass grafting. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.

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“…A study by Ibrahim et al (23) showed a trend toward improved patency with clopidogrel in addition to aspirin alone, but the difference did not reach statistical significance. The ongoing Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) trial will assess the addition of clopidogrel to aspirin using angiography and intravascular ultrasound one year after the operation (24).…”

Section: Prevention Antiplatelet Therapymentioning

confidence: 95%