Superiority of Clopidogrel Versus Aspirin in Patients With Prior Cardiac Surgery

Bhatt, Deepak L.; Chew, Derek P.; Hirsch, Alan T.; Ringleb, Peter A.; Hacke, Werner; Topol, Eric J.

doi:10.1161/01.cir.103.3.363

Cited by 252 publications

(120 citation statements)

References 51 publications

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“…First, more prolonged potent platelet inhibition may be required for prior CABG patients. Bhatt et al 27 reported a significant reduction in recurrent ischemic deaths in prior CABG patients receiving prolonged clopidogrel treatment. Potentially, a synergistic effect may be achieved by combination therapy with early intravenous GP IIb/IIIa blockade followed by prolonged thienopyridine treatment.…”

Section: Labinaz Et Al Outcome In Prior Cabg Patients With Acs 325mentioning

confidence: 99%

Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting

et al. 2002

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Background — Patients with prior CABG with a subsequent non–ST-segment elevation acute coronary syndrome (ACS) pose an increasingly important clinical problem. Although GP IIb/IIIa inhibitors have improved the outcome of patients with ACS, their efficacy in patients with prior CABG has not been previously evaluated. Methods and Results — We analyzed the 30- and 180-day outcomes of patients with prior CABG enrolled in the Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) trial. In this trial, which evaluated the efficacy of eptifibatide in patients with ACS, 1134 patients (12%) with prior CABG and 8321 without prior CABG were enrolled. After adjusting for differences in baseline characteristics and treatment, patients with prior CABG had a significantly higher mortality rates at 30 days (hazard ratio [HR], 1.45 [95% CI, 1.06 to 1.98]; P =0.019) and at 180 days (HR, 1.32 [95% CI, 1.04 to 1.67]; P =0.021). At 30 days, there was a similar effect on the primary end point of death or myocardial infarction in the eptifibatide group versus the placebo group in prior CABG patients (unadjusted HR, 0.90 [95% CI, 0.67 to 1.20]) and in patients without a history of CABG (unadjusted HR, 0.89 [95% CI, 0.80 to 0.99]). Conclusions — Patients with prior CABG with non–ST-segment elevation ACS have a significantly worse prognosis than do patients without a history of CABG. The treatment effect of eptifibatide in the prior CABG group was similar to the effect seen in patients without prior CABG.

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Section: Labinaz Et Al Outcome In Prior Cabg Patients With Acs 325mentioning

confidence: 99%

Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting

et al. 2002

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“…The antiplatelet thienopyridine agents clopidogrel 92,93 and ticlopidine 85 are adenosine diphosphate receptor antagonists that have been shown to reduce ischemic events in ACS patients. When given in addition to aspirin, these agents reduce the rates of subacute stent thrombosis after stent implantation.…”

Section: Thienopyridines: Ticlopidine and Clopidogrelmentioning

confidence: 99%

Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women

Lansky¹,

Hochman²,

Ward³

et al. 2005

Circulation

214

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Abstract-More than 1.2 million percutaneous coronary interventions are performed annually in the United States, with only an estimated 33% performed in women, despite the established benefits of percutaneous coronary intervention and adjunctive pharmacotherapy in reducing fatal and nonfatal ischemic complications in acute myocardial infarction and high-risk acute coronary syndromes. This statement reviews sex-specific data on the safety and efficacy of contemporary interventional therapies in women. 1 Despite the fact that more women than men die from cardiovascular disease in the United States, and despite the established benefits of PCI in reducing fatal and nonfatal ischemic complications in patients with acute myocardial infarction and high-risk acute coronary syndromes, only an estimated 33% of annual PCIs are performed in women. [1][2][3][4] In addition, women experience greater delays 5 to intervention and are referred for diagnostic catheterization less frequently than are men. 6 -8 Although suggested reasons for referral differences have included women's older age at presentation, greater risk profile, and increased risk for an adverse procedural outcome, as well as differences in symptoms and pain perception between men and women and lower predictive accuracy of noninvasive testing in women, some evidence suggests a potential sex and race bias. 9 In contrast, once women are referred for cardiac catheterization, revascularization rates and practices are similar to those in men. 10 -12 Recent advances in angioplasty equipment and technique have improved options for patients with smaller coronary and peripheral (access) arteries. In addition, the increased use of stents and adjunctive pharmacotherapy has improved outcomes in both women and men. Nevertheless, women continue to represent 15% to 38% of the population in studies of PCI, and still relatively few sex-or race-specific data exist.The purpose of this statement is to review what is known and not known about PCI in women and to put published data in context with contemporary coronary intervention. It is not the intention of the writing group to give specific treatment recommendations but rather to compile and collate the available sex-specific data on the safety and efficacy of interventional therapies in women. Tables 1 and 3 provide summaries of the findings in women drawn from this literature review, as well as recommendations from previously published American College of Cardiology/American Heart Association (ACC/AHA) guidelines. MethodsThe information in this statement was compiled by systematic literature review. By searching MEDLINE from JanuaryThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perc...

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“…In the CURE trial, patients that interrupted Clopidogrel treatment within 5 days prior to CABG had a trend towards more bleeding than those patients in the control placebo group [18]. The drug In all other cases, the risk of bleeding must be weighted against the risks of delaying the surgery (unstable angina, myocardial infarction, hemodynamic compromise) [19]. In our experience, Clopidogrel exposure within 3 days prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and surgical re-exploration.…”

Section: Discussionmentioning

confidence: 99%

Impact of clopidogrel in coronary artery bypass grafting*1

ENGLBERGER¹

2004

European Journal of Cardio-Thoracic Surgery

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Objective: Clopidogrel has become the standard of care to prevent thrombotic complications following cardiological interventions, in particular intracoronary stenting. In addition, patients with aspirin intolerance and those with carotid and peripheral vascular disease are also increasingly treated with clopidogrel. Platelet inhibition may become a concern for hemostasis in patients treated with clopidogrel who need emergency and undelayed surgery. Methods: We prospectively analyzed the intra-and postoperative outcome of 505 consecutive patients who underwent isolated CABG and compared two groups: those with clopidogrel exposure until 72 h prior to surgery ðn ¼ 136Þ with those without exposition to clopidogrel ðn ¼ 369Þ: Patients undergoing emergency surgery because of failed PTCA and cardiogenic shock, associated valvular surgery, redo-CABG, and those with additional platelet IIb/IIIa receptor inhibitor exposure were excluded. Patients who received aspirin and/or heparin treatment prior to surgery were not excluded. Results: Patients who received clopidogrel had a higher prevalence of angina class III or IV (67 vs 39%, P , 0:01), received more often revascularization within 48 h (41 vs 14%, P ¼ 0:02), and had received more frequently stenting (57 vs 13%). Chest tube drainage was significantly increased during the first 24 h following CABG in the group of patients who had clopidogrel treatment (1485 vs 780 ml, P ¼ 0:003) These patients also required more transfusion of platelets and fresh frozen plasma. Overall re-exploration rate because of bleeding was significantly higher in the clopidogrel group (5.9 vs 1.2%, P , 0:01). Platelets transfused before chest closure had a beneficial effect on preservation of the hemostasis. Conclusions: Clopidogrel exposure 3 days or less prior to CABG surgery significantly increases the risk of postoperative bleeding, the need for perioperative transfusion and the incidence of re-exploration. Surgery should be performed using standard heparinization and anti-fibrinolytic strategies but aggressive correction of platelets dysfunction is required before chest closure. q

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Superiority of Clopidogrel Versus Aspirin in Patients With Prior Cardiac Surgery

Cited by 252 publications

References 51 publications

Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting

Outcomes of Patients With Acute Coronary Syndromes and Prior Coronary Artery Bypass Grafting

Percutaneous Coronary Intervention and Adjunctive Pharmacotherapy in Women

Impact of clopidogrel in coronary artery bypass grafting*1

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