Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion

Abstract

KEYWORDS: Ticlopidine, acenocoumarol, platelet inhibitors, anticoagulants, coronary bypass patency rate. Introduction platelet aggregation and prolonging bleeding time; Long standing patency of aorto-coronary a P otent antithrombotic activity has also been bypass grafts is essential for good subjective and shown in animal models" 8 '. In mongrel dogs objective results of surgical myocardial pretreatment with ticlopidine reduced adhesion revascularization" 21 . About 10% of bypass grafts and aggregation of platelets on arterial dacron become occluded within days of insertion and g rafts and significantly increased their patency rate 16-26% during the first postoperative year"-61 .U P t0 6 weeks after implantation" 91 . In a Thrombosis plays an important role in early graft randomized blinded clinical trial reported preocclusion. while later obstruction is caused mainly viously from this institution, ticlopidine or placebo by intimal proliferation and atherosclerosis 13 " 5) . were started 3 da y s before b yP ass surgery and were For prevention of thrombosis, oral anticoagulants continued until angiography 3 months postand platelet active drugs, namely aspirin, alone or operatively; in addition all patients postoperatively in combination with dipyridamole as well as received acenocoumarol as an oral anticosulfinpyrazone have been tested in animal experagulant 1201 . When very severe bleeding occurred in iments [781 and in clinical trials 169 " 171 .

Left Ventricular Thrombi: Changes in Size and in Platelet Deposition during Treatment with Indobufen and Ticlopidine

“…Ticlopidine is a new antiplatelet drug that can interrupt platelet aggregation induced by adenosine diphos phate, arachidonic acid, thrombin, adrena line and thromboxane Aj [19,22,23], In vivo, this drug increases platelet survival in recent Dacron grafts, decreases labeled platelet deposition on tetrafluorethylene grafts, and reduces the thrombus develop ment in polyethylene arteriovenous shunt [24][25][26]. In humans, it reduces the rate of aortocoronary bypass graft occlusion [27], but it does not inhibit platelet deposition on Dacron aortic prostheses [12], Indobufen is a new platelet inhibitor commonly used in Europe, and the mecha nism by which this drug exerts its action is similar to ASA. In vitro, indobufen inter rupts platelet aggregation induced by adeno sine diphosphate and collagen, and seems to be more effective than the association ASAdipyridamole or ASA alone [28,29], A re cent study suggests that indobufen improves symptoms in patients with ischemic cardiac disease [30], but no data are available on the deposition of the platelets on thrombus sur face.…”

Advances in Coronary Heart Disease Surgery in Latin America

“…With regard to anticoagulation, some randomized trials suggested an early benefit to this strategy. 34 However, ticlopidine, 35 like aspirin, has been shown to be as effective as anticoagulation added to aspirin in terms of continuation and maintenance of graft conduit patency. 36 The sustained role of anticoagulation in the context of coronary surgery could be defied by the recent assays on bivalirudina administered during the intervention itself.…”

Antithrombotic therapy in the coronary vein graft patient

“…Rothlin ef al. 30 compared the platelet inhibitor ticlopidine (250 mg twice daily) with acenocoumarol, an oral anticoagulant, without the use of a control group. At 3-month angiographic follow-up, graft patency was 84% with ticlopidine and 82% in the acenocoumarol group.…”