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ASpirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG): A Randomized, Double-Blind, Placebo-Controlled Pilot Trial

Ahmad M. Slim, Emilio Fentanes, Dustin M. Thomas, Jennifer N. Slim, Taylor Triana, Homayoun R. Ahmadian, Ryan J. McDonough, Jason Saucedo, Norma J. Suarez, Dorette Pearce-Moore, H. Lester Kirchner, Edward Hulten, Ricardo C. Cury, Kelley Branch

Journal of Advances in Medicine and Medical Research · pp. 1–10 · Published 2 Mar 2016

10.9734/BJMMR/2016/24386

Abstract

Background: Vein graft thrombosis is the leading cause of acute graft failure within the first post-operative month. Several studies have shown the benefit of post-operative dual anti-platelet therapy (DAPT) in preventing acute graft thrombosis. The purpose of this study was to determine whether peri-operative initiation of DAPT will improve short and intermediate term graft patency. Methods: This was a randomized, double-blind, placebo controlled trial of 20 patients undergoing CABG to compare DAPT versus aspirin monotherapy. The primary outcome was post-operative graft patency at 2 and 52 weeks determined by <50% bypass graft stenosis by cardiac computed tomography angiography (CCTA). The secondary outcomes were (1) major adverse cardiovascular events (MACE), defined as myocardial infarction, thrombotic events, and angina, and (2) safety end-points defined as TIMI major and minor bleeding events. Results: The study population consisted predominately of men (19/20 patients). At 2 weeks, all LIMA grafts were patent although vein graft patency for the DAPT group was only 83.3% (20/24) compared to 89.5% (17/19) for placebo (p=0.597). At 52 weeks, the patency rate in the placebo group was 52.6% (10/19) as compared to a patency of 71.4% (15/24) in the dual anti-platelet therapy arm (p=0.244).  Conclusion: The addition of clopidogrel to aspirin post-bypass surgery did not significantly improve venous graft patency at 2 weeks but trended toward higher graft patency at 52 weeks.

Aspirin Plavix CCTA coronary artery bypass surgery graft patency major adverse cardiovascular events

References (31)

  1. 1 Clopidogrel and Aspirin versus Aspirin Alone for the Prevention of Atherothrombotic Events [DOI]
  2. 2 Aortocoronary Saphenous Vein Graft Disease [DOI]
  3. 3 A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease [DOI]
  4. 4 SCCT guidelines for performance of coronary computed tomographic angiography: A report of the Society of Cardiovascular Computed Tomography Guidelines Committee [DOI]
  5. 5 Development of aspirin resistance in persons with previous ischemic stroke. [DOI]
  6. 6 Functional and Biochemical Evaluation of Platelet Aspirin Resistance After Coronary Artery Bypass Surgery [DOI]
  7. 7 Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting [DOI]
  8. 8 Acute Clopidogrel Use and Outcomes in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery [DOI]
  9. 9 Aspirin Plus Clopidogrel Therapy Increases Early Venous Graft Patency After Coronary Artery Bypass Surgery [DOI]
  10. 10 Dual Anti-platelet Therapy After Coronary Artery Bypass Grafting: Is There Any Benefit? A Systematic Review and Meta-Analysis [DOI]
  11. 11 Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery: results from the CRYSSA (prevention of Coronary arteRY bypaSS occlusion After off-pump procedures) randomised study [DOI]
  12. 12 Comparison of Graft Patency Between Off-Pump and On-Pump Coronary Artery Bypass Grafting: An Updated Meta-Analysis [DOI]
  13. 13 Superiority of Clopidogrel Versus Aspirin in Patients With Prior Cardiac Surgery [DOI]
  14. 14 Early Potent Antithrombotic Effect With Combined Aspirin and a Loading Dose of Clopidogrel on Experimental Arterial Thrombogenesis in Humans [DOI]
  15. 15 Individual variation in the effects of ASA on platelet function: implications for the use of ASA clinically.
  16. 16 Comparative Benefits of Clopidogrel and Aspirin in High-Risk Patient Populations [DOI]
  17. 17 Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts [DOI]
  18. 18 Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graft occlusion: the Preoperative Aspirin and Postoperative Antiplatelets in Coronary Artery Bypass Grafting study [DOI]
  19. 19 Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts [DOI]
  20. 20 Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study☆ [DOI]
  21. 21 Clopidogrel and Aspirin Versus Clopidogrel Alone on Graft Patency After Coronary Artery Bypass Grafting [DOI]
  22. 22 Meta-Analysis of Effect of Single Versus Dual Antiplatelet Therapy on Early Patency of Bypass Conduits After Coronary Artery Bypass Grafting [DOI]
  23. 23 Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting [DOI]
  24. 24 Effect of Clopidogrel Use Post Coronary Artery Bypass Surgery on Graft Patency [DOI]
  25. 25 Comparison of long-term usefulness of clopidogrel therapy after the first percutaneous coronary intervention or coronary artery bypass grafting versus that after the second or repeat intervention [DOI]
  26. 26 Evidence for Using Clopidogrel Alone or in Addition to Aspirin in Post Coronary Artery Bypass Surgery Patients [DOI]
  27. 27 Clopidogrel Is Safe Early after On- and Off-pump Coronary Artery Bypass Surgery [DOI]
  28. 28 The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery [DOI]
  29. 29 Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting [DOI]
  30. 30 The Role of Clopidogrel and Acetylsalicylic Acid in the Prevention of Early-Phase Graft Occlusion Due to Reactive Thrombocytosis after Coronary Artery Bypass Operation [DOI]
  31. 31 ANTIPLATELET AND ANTICOAGULANT THERAPY IN THE SECONDARY PREVENTION OF ISCHEMIC HEART DISEASE [DOI]

Cited by 24

Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting

Nayan Agarwal, Ahmed N. Mahmoud, Nimesh Kirit Patel · The American Journal of Cardiology · 2018

Antiplatelet therapy and coronary artery bypass grafting: a systematic review and network meta-analysis

Saurabh Gupta, Emilie P Belley-Cote, Puru Panchal · Interactive CardioVascular and Thoracic Surgery · 2020

Dual versus single antiplatelet therapy after coronary artery bypass graft surgery: An updated meta-analysis

Rhanderson Cardoso, Leonardo Knijnik, Seamus P. Whelton · International Journal of Cardiology · 2018

Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular events

Alessandro Squizzato, Marta Bellesini, Andrea Takeda · Cochrane Database of Systematic Reviews · 2017

Ticagrelor-based antiplatelet regimens in patients treated with coronary artery bypass grafting: a meta-analysis of randomized controlled trials

Moritz von Scheidt, Dario Bongiovanni, Ulrich Tebbe · European Journal of Cardio-Thoracic Surgery · 2019

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