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The use of aspirin in the immediate postoperative period after coronary artery bypass grafting (CABG) has been shown to improve survival, graft patency and reduces ischemic events. Results of studies comparing the combination of clopidogrel and aspirin versus aspirin alone after CABG have been conflicting.
A search strategy for MEDLINE and PubMed for all English and non-English articles including coronary bypass surgery and clopidogrel was created. Two reviewers independently performed the search and applied predetermined inclusion and exclusion criteria for randomized controlled trials (RCTs) comparing combination clopidogrel and aspirin therapy to aspirin alone after CABG. The primary outcome was graft patency and safety was measured using bleeding events. Outcomes were pooled using a fixed effects model and Mantel-Hansel odds ratios were used.
Four RCTs were included involving 761 patients (380 clopidogrel and aspirin, 381 aspirin alone) of whom 683 (89.8%) underwent follow-up imaging of 2,252 bypass grafts to check for patency. Follow-up imaging took place at 50-365 days after surgery. Meta-analysis showed improved overall graft patency for patients receiving combined clopidogrel and aspirin versus aspirin alone (OR 1.58 [1.13,2.21]). Subgroup analysis by graft type showed a significant reduction in saphenous vein graft failure (OR 1.68 [1.16,2.43]) with clopidogrel use but not for internal mammary arteries or radial artery grafts. There was no difference detected in total bleeding events between the two groups (0.92 [0.44,1.92]).
The addition of clopidogrel to aspirin in the immediate postoperative period after CABG is safe and improved overall graft patency driven mainly by a reduction in saphenous vein graft failure.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Therapeutic Approaches in Chronic CAD and Stable Ischemic Heart Disease
Abstract Category: 11. Chronic CAD/Stable Ischemic Heart Disease: Therapy
Presentation Number: 1281-60
- 2013 American College of Cardiology Foundation