Clopidogrel and Aspirin After Surgery for Coronary Artery Disease - Clopidogrel and Aspirin After Surgery for Coronary Artery Disease
The goal of the trial was to compare treatment with aspirin plus clopidogrel compared with aspirin alone among patients undergoing coronary artery bypass grafting (CABG).
Aspirin plus clopidogrel will be more effective in improving early bypass graft patency.
- Patients undergoing elective CABG
Number of enrollees: 249
Duration of follow-up: 3 months
Mean patient age: 58 years
Percentage female: 18%
Ejection fraction: 60%
- Thrombocytopenia (<100 x 109/L) or polycythemia (>300 x 109/L)
- Previous CABG or cardiac surgery
- Need for concomitant valve or aorta surgery
- Renal insufficiency
- Left ventricular systolic dysfunction (<30%)
- Aspirin or clopidogrel within 7 days of surgery
- Liver disease
- Need for perioperative warfarin
- Active gastroduodenal ulcer or gastrointestinal bleeding
- Large postoperative pleural effusion
- Reoperation for tamponade due to bleeding
- Postoperative low cardiac output syndrome or need for inotropic support and/or intra-aortic balloon pump
- Clinical instability
- Graft occlusion assessed by multi-slice computed tomography at 3 months
- Major adverse cardiac events, defined as cardiovascular death, myocardial infarction, and repeat revascularization
After successful CABG, Chinese patients were randomized to aspirin (100 mg) plus clopidogrel (75 mg; n = 124) versus aspirin (100 mg) alone (n = 125) when chest tube drainage was ≤30 cc/h for 2 hours.
Overall 249 patients were randomized. There was no difference in baseline characteristics among the participants. In the aspirin plus clopidogrel group, the mean age was 58 years, 18% were women, mean body mass index was 26 kg/m2, 40% were diabetics, preoperative left ventricular ejection fraction was 60%, off-pump CABG was performed in 64%, and the mean number of grafts was 3.2 per patient.
The primary outcome, overall graft occlusion at 3 months, occurred in 6.5% of the aspirin plus clopidogrel group versus 10.3% of the aspirin alone group (p = 0.073). Saphenous vein grafts occluded in 8.4% versus 14.3% (p = 0.043), internal mammary artery grafts occluded in 1.8% versus 0.9% (p = 0.58), and radial artery grafts occluded in 25% versus 33% (p = 0.81), respectively.
Among Chinese patients undergoing CABG, the use of aspirin plus clopidogrel may be beneficial compared with aspirin alone. Dual antiplatelet therapy was associated with a nonsignificant reduction in overall graft occlusion and a significant reduction in saphenous vein graft occlusion at 3 months. These findings contrast with the smaller, though placebo-controlled CASCADE trial, which found no difference in overall graft patency at 1 year. The definitive study on this topic has yet to be conducted.
Gao G, Zheng Z, Pi Y, et al. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery: a single-center randomized controlled trial. J Am Coll Cardiol 2010;56:1639-43.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention
Keywords: Platelet Aggregation Inhibitors, Radial Artery, Ticlopidine, Purinergic P2Y Receptor Antagonists, Body Mass Index, Saphenous Vein, Drainage, Mammary Arteries, Stroke Volume, Chest Tubes, Coronary Artery Bypass, Diabetes Mellitus
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