Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graft occlusion: the Preoperative Aspirin and Postoperative Antiplatelets in Coronary Artery Bypass Grafting study

Secondary Prevention After Coronary Artery Bypass Graft Surgery

“…Unlike aspirin, clopidogrel does not appreciably inhibit platelet aggregation during the first 5 postoperative days after coronary surgery, 38 and it is not until days 9 to 28 after CABG that the antiplatelet effects of clopidogrel (at daily doses of 75 mg) become apparent. 39 In a subsequent placebo-controlled trial, Sun et al 40 used partial blinding to compare the combination of postoperative clopidogrel 75 mg and aspirin 81 mg daily with aspirin 81 mg alone among 100 patients undergoing on-pump CABG. Graft patency was assessed with computed tomography angiography, which was performed for 79 patients at 1 month.…”

Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting in the Setting of Acute Coronary Syndrome

“…20 In the 79 patients who underwent computed tomography angiography, the incidence of 1 or more occluded grafts was similar between the groups (DAPT 17% vs. ASA 23%, RR 0.95 (95% CI 0.80-1.14); p=0.54. Among the patients with radial grafts, there was a trend to superiority for the DAPT group.…”

“…13,15 The remaining 4 papers examining graft patency found no benefit from DAPT overall or in any specific type of graft. 18,[20][21][22] It is possible that a prospective, study examining an ACS CABG population would result in similar benefits as seen in other management strategies.…”

“…A total of 12 studies including efficacy endpoints were identified on this subject with varying results. [11][12][13][14][15][16][17][18][19][20][21][22] In general, the studies conducted to date include small patient populations with surrogate end points. Three metaanalyses have been conducted evaluating DAPT post CABG.…”

“…[16][17][18][19][20][21][22] In 2004, subgroups of patients who underwent CABG from the CURE and CREDO trials were published. 16,17 As described previously, the overall results from the CURE trial found a significant benefit of DAPT in an ACS population of unstable angina and non ST-segment elevation MI patients.…”