Abstract |
Background The optimal antiplatelet strategy for patients with acute coronary syndromes who require coronary artery bypass surgery remains unclear. While a more potent antiplatelet regimen will predispose to perioperative bleeding, it is hypothesized that through "platelet quiescence," ischemic protection conferred by such therapy may provide a net clinical benefit. Methods and Results We compared patients undergoing coronary artery bypass surgery who were treated with a more potent antiplatelet inhibition strategy with those with a less potent inhibition through a meta-analysis. The primary outcome was all-cause mortality after bypass surgery. The analysis identified 4 studies in which the antiplatelet regimen was randomized and 6 studies that were nonrandomized. Combining all studies, there was an overall higher mortality with weaker strategies compared with more potent strategies (odds ratio, 1.38; 95% CI, 1.03-1.85; P=0.03). Conclusions Our findings support the concept of platelet quiescence, in reducing mortality for patients with acute coronary syndrome requiring coronary artery bypass surgery. This suggests the routine up-front use of potent antiplatelet regimens in acute coronary syndrome, irrespective of likelihood of coronary artery bypass graft.
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Authors | Kiran Sarathy, George A Wells, Kuljit Singh, Etienne Couture, Aun Yeong Chong, Fraser Rubens, Marie Lordkipanidzé, Jean-François Tanguay, Derek So |
Journal | Journal of the American Heart Association
(J Am Heart Assoc)
Vol. 10
Issue 5
Pg. e016602
(02 2021)
ISSN: 2047-9980 [Electronic] England |
PMID | 33599134
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
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Chemical References |
- Platelet Aggregation Inhibitors
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Topics |
- Acute Coronary Syndrome
(blood, therapy)
- Blood Platelets
(physiology)
- Coronary Artery Bypass
- Humans
- Platelet Aggregation Inhibitors
(therapeutic use)
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