Effect of Clopidogrel Use Post Coronary Artery Bypass Surgery on Graft Patency

Autor: Todd H. Wagner, Janet H. Baltz, Ramin Ebrahimi, Abbas Ardehali, Brack Hattler, Faisal G. Bakaeen, Abhimanyu Uberoi, A. Laurie Shroyer, G. Hossein Almassi, Joseph F. Collins, Frederick L. Grover
Rok vydání: 2014
Předmět:
Male
Time Factors
Bypass grafting
Coronary Artery Bypass
Off-Pump
Coronary Disease
Coronary Angiography
Coronary artery bypass surgery
Reference Values
Prospective Studies
Coronary Artery Bypass
Aged
80 and over
Aspirin
Graft Occlusion
Vascular
Middle Aged
Clopidogrel
Treatment Outcome
surgical procedures
operative
medicine.anatomical_structure
Cardiology
Regression Analysis
Education
Medical
Continuing
Female
Cardiology and Cardiovascular Medicine
circulatory and respiratory physiology
Artery
medicine.drug
Adult
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Ticlopidine
Detailed data
Drug Administration Schedule
Internal medicine
medicine
Humans
cardiovascular diseases
Vascular Patency
Aged
Postoperative Care
Dose-Response Relationship
Drug
Graft patency
business.industry
Surgery
Clinical trial
Multivariate Analysis
business
Platelet Aggregation Inhibitors
Follow-Up Studies
Zdroj: The Annals of Thoracic Surgery. 97:15-21
ISSN: 0003-4975
DOI: 10.1016/j.athoracsur.2013.08.058
Popis: Clopidogrel use post coronary artery bypass grafting (CABG) has become more popular under the assumption that it improves graft patency. The purpose of this sub-analysis from the Randomized On and Off-Pump Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG to improve graft patency when added to standard aspirin therapy.The ROOBY trial was a multi-center, randomized, controlled clinical trial that compared on-pump versus off-pump coronary artery bypass grafting (CABG). Clopidogrel use post CABG was left at the discretion of the operator. Detailed data regarding the use and timing of clopidogrel post CABG were collected prospectively, along with 1-year angiograms to evaluate graft status.Of the 2,203 subjects undergoing CABG, 953 patient records had complete clopidogrel use and 1-year angiographic data. Of these, 345 (36.2%) received clopidogrel post CABG prior to discharge. Compared with patients with no post-CABG clopidogrel use, baseline characteristics were similar for the clopidogrel group except for the following: lower preoperative aspirin use (80.2% vs 86.7%, p = 0.009); higher preoperative clopidogrel use (23.5% vs 14.0%, p0.001), less on-pump (35.9% vs 55.9%, p0.0001); and lower endoscopic vein harvesting (30.8% vs 42.5%, p0.001) rates. Overall 1-year graft patency rates were not different between the clopidogrel and no-clopidogrel groups (86.5% vs 85.3%, p = 0.43). Multivariable analyses did not alter these findings.This study suggests that routine post-CABG clopidogrel use may not translate to improved 1-year graft patency. Future studies appear warranted to better define the role of more aggressive antiplatelet therapy post CABG on graft patency and clinical outcomes.
Databáze: OpenAIRE
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