The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting. </jats:p></jats:sec>

Dual Anti-platelet Therapy After Coronary Artery Bypass Grafting: Is There Any Benefit? A Systematic Review and Meta-Analysis

“…A total of 696 articles were identified with the literature search. Eleven studies (five randomized control trials and six observational studies) comprising a pooled cohort of 25,728 patients met our criteria and were included in this meta‐analytical review. Selection of articles for inclusion in this study resulted in a Cohens κ score of 0.90.…”

“…Characteristics of the included studies in reported in Tables and . Most studies included patients undergoing both on‐ and off‐pump CABG; however, four studies included patients with off‐pump CABG.…”

“…The primary outcome of saphenous vein graft patency was evaluated using coronary angiography or computerized tomography. Kulik et al and Mujanovic et al utilized coronary angiography to determine saphenous vein graft patency, while the remaining three studies have used computerized tomography. Each study protocol incorporated this testing as a routine procedure and it was not done based on patient symptomatology at follow‐up.…”

“…Each study protocol incorporated this testing as a routine procedure and it was not done based on patient symptomatology at follow‐up. While Sun et al performed the test one month from surgery, the other authors have conducted this investigation at three months and one year from surgery. Additional outcomes analyzed included 30‐day/in‐hospital mortality, angina or myocardial infarction, and major bleeding events defined as substantially disabling bleeding, intraocular bleeding leading to loss of vision or bleeding which required transfusion of more than two units of blood.…”

“…The protocol for administration of aspirin/clopidogrel demonstrated some variation among studies. Three studies implemented a loading dose of the medications after chest tube drain had reduced . The dose of aspirin was 81, 100, or 325 mg orally.…”