Indirect comparison meta-analysis of aspirin therapy after coronary surgery

Lim, Eric; Ali, Ziad A.; Ali, Ayyaz; Routledge, Tom; Edmonds, Lyn; Altman, Douglas G.; Large, Stephen

doi:10.1136/bmj.327.7427.1309

Cited by 72 publications

(38 citation statements)

References 49 publications

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“…Aspirin 325 mg may be considered as a high dose for antiplatelet effect, nevertheless it is still considered as a valid dosage and prescribed in coronary artery disease [34,35]. Our results cannot be generalized to lower dosages of aspirin.…”

Section: Discussioncontrasting

confidence: 53%

Comparative effect of aspirin and clopidogrel on arterial function in CHF

Meune

Mahé

Solal

et al. 2006

International Journal of Cardiology

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Section: Discussioncontrasting

confidence: 53%

Comparative effect of aspirin and clopidogrel on arterial function in CHF

Meune

Mahé

Solal

et al. 2006

International Journal of Cardiology

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“…On the other hand, there are no clinical studies that directly compared low, medium, and high-dose aspirin regimens. Lim et al [45] evaluated the efficacy of low-dose aspirin (75-150 mg) in comparison to medium dose therapy (300-325 mg) on vein graft patency after CABG using indirect comparison meta-analysis. The pooled relative risk reduction for graft occlusion was 45% in the medium dose trials (0.55, 95% CI 0.41-0.73) compared with 26% in the low-dose trials (0.74, 95% CI 0.60-0.91), with a relative risk ratio of 0.74 (0.52-1.06; p = 0.10), indicating no statistical difference in vein graft occlusion rates between medium and low-dose aspirin.…”

Section: Dosage Of Aspirinmentioning

confidence: 99%

Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent

Zimmermann

Gams

Hohlfeld

2008

European Journal of Cardio-Thoracic Surgery

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The success of coronary artery bypass graft surgery (CABG) depends mainly on the patency of the graft vessels. Aortocoronary vein graft disease is comprised of three distinct but interrelated pathological processes: thrombosis, intimal hyperplasia and atherosclerosis. Early thrombosis is a major cause of vein graft attrition during the first month after CABG, while during the remainder of the first year, intimal hyperplasia forms a template for subsequent atherogenesis, which thereafter predominates. Platelets play a crucial role in the pathophysiology of graft thrombosis and aspirin is the primary antiplatelet drug that has been shown to improve vein graft patency within the first year after CABG. Nevertheless, a significant number of grafts still occlude in the early postoperative period despite 'appropriate' aspirin treatment. Moreover, laboratory investigations showed that the expected inhibition of platelet function is not always achieved. This has been called 'aspirin nonresponse' or 'aspirin resistance', although a uniform definition is lacking. The finding that a considerable number of patients show an impaired antiplatelet effect of aspirin after CABG brought new insight into the discussion concerning poor patency rates of bypass grafts: the early period after CABG shows a coincidence of an increased risk for bypass thrombosis (amongst others, due to platelet activation and endothelial cell disruption of the graft) and an increased prevalence of aspirin resistance. Hitherto, the underlying mechanisms of aspirin resistance are uncertain and largely hypothetical; amongst others, increased platelet turnover, enhanced platelet reactivity, systemic inflammation, and drug-drug interaction are discussed. Up to now available data concerning the clinical outcome of aspirin resistant CABG patients are limited, and there is evidence that platelets of patients with graft thrombosis are more likely to be resistant to aspirin compared with patients without thrombotic events. Many publications concerning aspirin resistance are available today, but reports addressing this topic in CABG patients are sparse. This review summarises recent insights into the antiplatelet treatment after CABG and describes the clinical benefit, but also the therapeutic failure of the well-established drug aspirin. Moreover, possible pharmacological approaches to improve antithrombotic therapy in aspirin nonresponders among CABG patients are discussed.

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“…All together, the authors recommended indefinite aspirin use postoperatively in doses of 100 to 325 mg daily. Subsequently, Lim et al 22 performed a meta-analysis of 5 randomized, controlled trials to compare the efficacy of low-dose (50-100 mg daily) and medium-dose (300-325 mg daily) aspirin therapy after CABG. Compared with low-dose aspirin, there was a trend toward an improvement in graft patency in favor of mediumdose aspirin (RR, 0.74; 95% CI, 0.52-1.06; P=0.10).…”

mentioning

confidence: 99%