Clopidogrel and Aspirin After Surgery for Coronary Artery Disease - Clopidogrel and Aspirin After Surgery for Coronary Artery Disease
Description:
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).
Hypothesis:
Aspirin plus clopidogrel will be more effective in improving early bypass graft patency.
Study Design
- Randomized
- Parallel
Patient Populations:
- 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%
Exclusions:
- 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
Primary Endpoints:
- Graft occlusion assessed by multi-slice computed tomography at 3 months
Secondary Endpoints:
- Major adverse cardiac events, defined as cardiovascular death, myocardial infarction, and repeat revascularization
Drug/Procedures Used:
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.
Principal Findings:
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.
Interpretation:
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.
References:
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.
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
< Back to Listings