Effect of Dipyridamole and Aspirin on Late Vein-Graft Patency after Coronary Bypass Operations

Abstract

To study the prevention of occlusion of aortocoronary-artery bypass grafts, we concluded a prospective, randomized, double-blind trial comparing long-term administration of dipyridamole (begun two days before operation) plus aspirin (begun seven hours after operation) with placebo in 407 patients. Results at one month showed a reduction in the rate of graft occlusion in patients receiving dipyridamole and aspirin. At vein-graft angiography performed in 343 patients (84 per cent) 11 to 18 months (median, 12 months) after operation, 11 per cent of 478 vein-graft distal anastomoses were occluded in the treated group, and 25 per cent of 486 were occluded in the placebo group. The proportion of patients with one or more distal anastomoses occluded was 22 per cent of 171 patients in the treated group and 47 per cent of 172 in the placebo group. All grafts were patent within a month of operation in 94 patients in the placebo group and 116 patients in the treated group; late development of occlusions was reduced from 27 per cent in the placebo group to 16 per cent in the treatment group. The results show that dipyridamole and aspirin continue to be effective in preventing vein-graft occlusion late after operation, and we believe that such treatment should be continued for at least one year.

Coronary vein graft disease: Pathogenesis and prevention

“…Chesebro et al (17,18) studied a group of patients undergoing CABG at the Mayo Clinic (Rochester, Minnesota) from 1977 to 1981. All patients received dipyridamole two days before the operation.…”

Secondary prevention of heart disease amongst patients with lipid abnormalities: practice and trends in the United States

“…Of patients undergoing this procedure for angina (many with two-and three-vessel disease), 70-80 % will enjoy sustained (3-year) pain relief, 15 % only transient or minor relief and 3 % will die. Early graft occlusion is effectively reduced by ASA [15,16]. Progressive atherothrombotic obstruction of the saphenous vein grafts limits the long-term effectiveness of CABG ; in many, angina recurs due to graft closure within 5-15 years [5,17,18].…”

“…The six cornerstones in the comprehensive medical management of established CAD include antithrombotic therapy, in particular aspirin [15,16,[19][20][21][22][23], antihypertensive therapy, diet, exercise [24][25][26], smoking cessation and treatment of lipid abnormalities [1,2]. The detailed discussion of each of these approaches is beyond the scope of this report.…”

Antiplatelet therapy with CABG: chaos in the Netherlands

“…Traditionally, antiplatelet therapy is the treatment of choice to protect grafts against occlusion [1]. Oral anticoagulants have shown to be effective as well [2], but not superior to antiplatelet agents [3].…”