Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study☆

Gurbuz, Ahmet Tayfun; Zia, Ayhan A.; Vuran, Ali Can; Cui, Haiyan; Aytaç, Aydın

doi:10.1016/j.ejcts.2005.11.033

Cited by 82 publications

(58 citation statements)

References 23 publications

(21 reference statements)

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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%

“…[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. Moreover, post hoc subgroup analyses from multicenter randomized controlled studies have suggested a benefit associated with clopidogrel in patients with a history of CABG or in patients who underwent CABG after trial enrollment.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting

et al. 2010

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“…In 2006 there were two prospective trials published supporting the thesis of safety of early dual antiplatelet therapy (aspirin and clopidogrel) after off-pump CABG. Moreover, those studies revealed some benefit of such a strategy in reduction of cardiac and vascular adverse events risk in a period of 30 days and 2 years [12,13]. Early administration of clopidogrel seems to play a key role as over-reactivity of platelets due to surgical trauma which occurs shortly after surgery and its suppression with a high dose of aspirin (300 mg 48 hours after chest closure) is not effective.…”

Section: Discussionmentioning

confidence: 99%

Aspirin versus clopidogrel after surgical offpump coronary revascularization – a prospective, randomized, head-to-head pilot trial

Suwalski¹,

Banach²,

Smoczyński³

et al. 2013

kitp

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8 StreszczenieWstęp: Zastosowanie klopidogrelu u pacjentów po chirurgicznej rewaskularyzacji serca może przynieść wczesną i odległą redukcję ryzyka wystąpienia niepożądanych zdarzeń sercowo-naczyniowych. Opublikowano niewiele prospektywnych badań z randomizacją porównujących terapię przeciwpłytkową jedynie kwasem acetylosalicylowym lub jedynie klopidogrelem w tej populacji. Cel pracy: Celem badania była ocena skuteczności i bezpieczeństwa prowadzenia terapii przeciwpłytkowej kwasem acetylosalicylowym lub klopidogrelem u pacjentów po planowej chirurgicznej rewaskularyzacji serca. Materiał i metody: Do badania zrandomizowano prospektywnie 50 pacjentów, u których po wykonanej operacji pomostowania tętnic wieńcowych bez zastosowania krążenia pozaustrojowego przez 6 miesięcy prowadzono terapię jedynie kwasem acetylosalicylowym (150 mg) lub jedynie klopidogrelem (75 mg), a następnie u wszystkich tylko kwasem acetylosalicylowym. W całej populacji chorych oznaczono stopień zablokowania pły-tek krwi przez kwas acetylosalicylowy. Po 1, 6 i 12 miesięcach przeprowadzono kontrolę wystąpienia zdarzeń niepożądanych. Wyniki: W czasie obserwacji odnotowano 26 zdarzeń niepożąda-nych, włączając w to powtórną rewaskularyzację, udar i krwawienia. W ramieniu klopidogrelu skumulowane ryzyko wystąpienia zdarzeń niepożądanych było istotnie niższe (14%) w porówna-niu z grupą, w której stosowano kwas acetylosalicylowy (25%, p < 0,05). U pacjentów z funkcją płytek niepoddającą się zablokowaniu kwasem acetylosalicylowym obserwowano najwyższe skumulowane ryzyko (35%). Z kolei najniższe ryzyko wystąpienia zdarzeń niepożądanych obserwowano u osób z przedoperacyjnie zablokowaną funkcją płytek przez kwas acetylosalicylowy i zrandomizowanych do ramienia klopidogrelu (2%). Wnioski: Zastosowanie klopidogrelu zamiast kwasu acetylosalicylowego w ciągu 6 miesięcy po chirurgicznej rewaskularyzacji serca jest bezpieczne i wydaje się poprawiać rokowanie w porównaniu z leczeniem jedynie kwasem acetylosalicylo- AbstractBackground: Postoperative clopidogrel use after surgical coronary revascularization may provide short-and long-term reduction of risk of negative cardiovascular events. However, there are not enough data from prospective randomized trials comparing head-to-head monotherapy with either aspirin or clopidogrel. Aim of the study: The aim of the study was to evaluate the safety and effectiveness of aspirin or clopidogrel use in patients after elective coronary artery bypass grafting. Material and methods: The study involved 50 patients who were referred for elective off-pump coronary artery bypass grafting (OPCAB). Preoperatively patients were randomized to postoperative antiplatelet treatment with either aspirin (150 mg per day) or clopidogrel for 6 months (75 mg per day). After 6 months all patients were turned to aspirin. In all patients platelet function on aspirin was checked before surgery. After 1, 6 and 12 months in all cases follow-up was collected in terms of any adverse events. Results: During follow-up 26 negative events occurred, in...

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“…DAPT was associated with increased risk of bleeding (RR 1.17, 95% CI 1.00-1.37). Furthermore, DAPT therapy appeared to be most beneficial in patients undergoing OPCAB (two observational studies and one RCT [48][49][50] RR 0.29, 95% CI 0.11-0.72) [47].…”

Section: Dual Antiplatelet Therapy (Dapt)mentioning

confidence: 99%

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

Jaaly¹,

Zakkar²,

Pufulete³

et al. 2015

J Integr Cardiol

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Coronary artery bypass grafting (CABG) remains the gold standard treatment in patients with complex multivessel coronary artery disease (CAD). Reversed long saphenous vein is the most commonly used conduit despite the known early thrombotic failure and low long-term patency rate. Post-operative antiplatelet therapy is an established treatment to improve graft patency and also a secondary treatment of the underlying native CAD.Aspirin has traditionally been the first line therapy; however, aspirin resistance especially in the early period after CABG, has been reported over the years and as a result, the use of dual antiplatelet therapy (DAPT) has become more common. However, there is limited evidence about the effect of DAPT and duration of use after CABG on graft patency, clinical outcomes (such as bleeding and myocardial infarction), and survival. The optimal dose of aspirin when given in DAPT is unclear and the duration of DAPT in association with quality of life is unknown.Furthermore, a better understanding of the pathology of vein graft disease and how available drugs influence it, could lead to the development of customised therapy for cohorts of patients undergoing CABG with potential benefits to early and long term outcomes. Here we review the available evidence on the routine use of DAPT after CABG. Coronary artery bypass grafting (CABG)Ischaemic heart disease (IHD) is the main leading cause of death in the world, with 7.4 million deaths in 2012 [1,2]. Coronary artery bypass grafting (CABG) is the gold standard intervention in patients with complex multivessel disease [3]. In the UK, there are about 25,000 CABG operations performed annually [4] and the majority of these operations is carried out on patients over 70 years of age [5]. Demand for CABG is likely to increase considerably in the future as a result of rapidly ageing populations [6] and increased expectations of patients and surgeons to expand their indications for surgery.During the early years of coronary surgery, saphenous vein grafts (SVGs) were the only conduits used [7]. Over the years different arterial conduits were introduced with variable degree of success [8][9][10]. Contemporary data on international use of grafts are available from the SYNTAX trial that included 1541 patients who underwent CABG at 85 sites in 18 countries between 2005 and 2007 [11]. The SYNTAX trial confirmed that the long saphenous vein (LSV) graft, is the most used conduit for multivessel revascularisation, despite its known low early and late patency rates.The underlying mechanism behind vein graft disease is multifactorial and can include conduit trauma/graft thrombosis (within 1 month, early failure), activation of intimal hyperplasia associated with harvest and implantation into the arterial high-pressure system (1 to 12 months, intermediate failure), superimposed atherosclerosis (beyond 12 months, late failure) [12][13][14][15]. A prospective cohort study of 1,388 patients carried out between 1969 to 1994, in which patency was assessed using coronary...

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Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study☆

Abstract: Clopidogrel therapy was independently associated with decreased symptom recurrence and adverse cardiac events following OPCAB. Extending clopidogrel use beyond 30 days did not have a significant effect on defined end points.

Cited by 82 publications

References 23 publications

Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting

Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting

Aspirin versus clopidogrel after surgical offpump coronary revascularization – a prospective, randomized, head-to-head pilot trial

http://oatext.com/Dual-antiplatelet-therapy-after-coronary-artery-bypass-grafting-Do-we-have-a-consensus.php

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