Abstract | BACKGROUND: METHODS: We searched OVID Medline, Cochrane, Scopus, and EMBASE for randomized control trials and observational studies comparing aspirin ± placebo to aspirin + clopidogrel after CABG. RESULTS: Eleven articles (five randomized control trials and six observational studies) including 25,728 patients met inclusion criteria. Early saphenous vein graft occlusion was reduced with the use of dual anti-platelet therapy (risk ratio (RR) = 0.59, 95% CI 0.43-0.82, p = 0.02). In-hospital or 30-day mortality was lower with aspirin + clopidogrel (0.8%) compared to aspirin alone (1.9%) (p < 0.0001), while risk of angina or perioperative myocardial infarction was comparable (RR = 0.60, 95% CI 0.31-1.14, p = 0.12). Patients treated with aspirin + clopidogrel demonstrated a trend towards a higher incidence of major bleeding episodes as compared to patients treated with aspirin alone (RR = 1.17, 95% CI 1.00-1.37, p = 0.05). In a pooled analysis of studies involving off-pump CABG compared to aspirin alone, dual anti-platelet therapy reduced the risk of perioperative myocardial infarction and saphenous graft occlusion by 68% (47% to 71%) and 55% (2% to 79%) respectively. CONCLUSION:
Dual anti-platelet therapy after CABG improved early saphenous vein graft patency, but may increase the risk of bleeding. The use of dual anti-platelet therapy appears to be most beneficial in patients undergoing off-pump CABG. Prospective randomized studies are necessary to determine whether this beneficial effect of dual therapy is also achieved in patients undergoing on pump CABG.
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Authors | Salil V Deo, Shannon M Dunlay, Ishan K Shah, Salah E Altarabsheh, Patricia J Erwin, Barry A Boilson, Soon J Park, Lyle D Joyce |
Journal | Journal of cardiac surgery
(J Card Surg)
Vol. 28
Issue 2
Pg. 109-16
(Mar 2013)
ISSN: 1540-8191 [Electronic] United States |
PMID | 23488578
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Copyright | © 2013 Wiley Periodicals, Inc. |
Chemical References |
- Platelet Aggregation Inhibitors
- Clopidogrel
- Ticlopidine
- Aspirin
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Topics |
- Angina Pectoris
(etiology, prevention & control)
- Aspirin
(therapeutic use)
- Clopidogrel
- Coronary Artery Bypass
(mortality)
- Drug Therapy, Combination
- Graft Occlusion, Vascular
(prevention & control)
- Humans
- Models, Statistical
- Myocardial Infarction
(etiology, prevention & control)
- Platelet Aggregation Inhibitors
(therapeutic use)
- Postoperative Care
(methods)
- Postoperative Complications
(chemically induced, prevention & control)
- Postoperative Hemorrhage
(chemically induced)
- Randomized Controlled Trials as Topic
- Ticlopidine
(analogs & derivatives, therapeutic use)
- Treatment Outcome
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