Evidence for Using Clopidogrel Alone or in Addition to Aspirin in Post Coronary Artery Bypass Surgery Patients

Patel, Jigar; Stoner, Julie A.; Owora, Arthur H.; Mathew, Sumi; Thadani, Udho

doi:10.1016/j.amjcard.2009.02.021

Cited by 30 publications

(15 citation statements)

References 27 publications

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“…Focus has primarily been on the necessity of ceasing clopidogrel treatment before surgery to prevent perioperative bleeding, but treatment benefits after CABG in high-risk patients have been suggested (10,11). Even though guidelines since 2004 have recommended that clopidogrel should be continued for a period of 9 to 12 months for acute coronary syndrome patients revascularized by CABG (12)(13)(14), concerns have been raised about the actual benefit of clopidogrel treatment for these patients (15). Clinical practices and the effect of clopidogrel treatment in real-life MI patients revascularized by CABG remains unclear.…”

mentioning

confidence: 99%

Efficacy of Post-Operative Clopidogrel Treatment in Patients Revascularized With Coronary Artery Bypass Grafting After Myocardial Infarction

Sørensen

Abildstrøm

Hansen

et al. 2011

Journal of the American College of Cardiology

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mentioning

confidence: 99%

Efficacy of Post-Operative Clopidogrel Treatment in Patients Revascularized With Coronary Artery Bypass Grafting After Myocardial Infarction

Sørensen

Abildstrøm

Hansen

et al. 2011

Journal of the American College of Cardiology

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“…Although substudies of large RCTs of antiplatelet therapy in patients with either CAD or recent ACS have examined clinical end points in patients with a history of remote CABG, these analyses do not suggest any signifi cant differences in the associated relative benefi t or harm compared with the overall study population. 3,[25][26][27] In addition, loss of bypass graft patency derives its patient importance from consequent MI and deaths. Additional reporting of graft patency along with MI and death would result in double counting of events and a distorted balance of benefi ts and harms.…”

Section: Secondary Prevention Of Cardiovascular Diseasementioning

confidence: 99%

Primary and Secondary Prevention of Cardiovascular Disease

Vandvik

Lincoff

Gore

et al. 2012

Chest

413

117

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“…(Clopidogrel does not appear to improve graft patency after off-pump revascularization procedures, either [ 63 ].) What is more, a systematic review by Patel and colleagues [ 64 ] found no clear benefi t of postoperative clopidogrel use for CABG patients.…”

Section: Graft Selection and Patencymentioning

confidence: 97%

Surgical Treatment of Coronary Artery Disease

Cohn

Frazier

Mallidi

et al. 2015

Coronary Artery Disease

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Techniques and technology for treating coronary artery disease (CAD) have evolved significantly over the past 50 years. Although there are cases in which the best treatment approach (medical, surgical, or catheter-based) is clear, the best choice of intervention is not obvious for the majority of patients. Five, seven, and ten years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar short-term survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CABG has been associated with longer-lasting revascularization.Technical innovations made in the attempt to reduce the negative impact of cardiopulmonary bypass (CPB) include reducing contact between blood and the CPB mechanism by coating the internal surface with heparin or other polymers, minimizing hemodilution by shrinking the bypass circuit to reduce the amount of crystalloid prime needed to start CPB, and using hemofi ltration to protect the heart and end organs. There is not yet complete agreement about the relative safety and effi cacy of off-pump coronary artery bypass (OPCAB) versus conventional CABG with CPB.Results of small randomized trials suggest that, in patients with stenosis of the proximal LAD, minimally invasive direct coronary artery bypass (MIDCAB) is associated with a longer in-hospital recovery period and higher costs than is direct stenting, but that MIDCAB produces similar or better short-and long-term outcomes. Totally endoscopic coronary artery bypass (TECAB) aided by computer-controlled surgical robotic devices has continued to slowly evolve over the last decade, and several centers have reported favorable results. The technical challenges and procedural costs have prevented the widespread application of this technology. • Techniques and technology for treating coronary artery disease (CAD) have evolved signifi cantly over the past 50 years.• Although there are cases in which the best treatment approach (medical, surgical, or catheterbased) is clear, the best choice of intervention is not obvious for the majority of patients.• Five, 7, and 10 years after initial treatment, mortality is lower for coronary artery bypass grafting (CABG) than for medical treatment alone. The survival benefi ts of CABG are particularly substantial for patients with 3-vessel or left main artery disease, severe angina, or a positive pretreatment exercise stress test.• Most trials that have compared CABG with percutaneous coronary intervention (PCI) in patients with multivessel disease have shown similar shortterm survival benefi ts, but PCI has been associated with less periprocedural morbidity, including stroke, whereas CA...

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Evidence for Using Clopidogrel Alone or in Addition to Aspirin in Post Coronary Artery Bypass Surgery Patients

Cited by 30 publications

References 27 publications

Efficacy of Post-Operative Clopidogrel Treatment in Patients Revascularized With Coronary Artery Bypass Grafting After Myocardial Infarction

Efficacy of Post-Operative Clopidogrel Treatment in Patients Revascularized With Coronary Artery Bypass Grafting After Myocardial Infarction

Primary and Secondary Prevention of Cardiovascular Disease

Surgical Treatment of Coronary Artery Disease

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