Faculty Collaboration Database

Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg 2014 Jan;97(1):15-21

Date

11/12/2013

Pubmed ID

24206971

DOI

10.1016/j.athoracsur.2013.08.058

Scopus ID

2-s2.0-84891627160 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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%, p < 0.001), less on-pump (35.9% vs 55.9%, p < 0.0001); and lower endoscopic vein harvesting (30.8% vs 42.5%, p < 0.001) 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.

CONCLUSIONS: 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.

Author List

Ebrahimi R, Bakaeen FG, Uberoi A, Ardehali A, Baltz JH, Hattler B, Almassi GH, Wagner TH, Collins JF, Grover FL, Shroyer AL

Author

G Hossein Almassi MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Coronary Angiography
Coronary Artery Bypass
Coronary Artery Bypass, Off-Pump
Coronary Disease
Dose-Response Relationship, Drug
Drug Administration Schedule
Education, Medical, Continuing
Female
Follow-Up Studies
Graft Occlusion, Vascular
Humans
Male
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors
Postoperative Care
Prospective Studies
Reference Values
Regression Analysis
Ticlopidine
Time Factors
Treatment Outcome
Vascular Patency