Document Detail


Evidence for using clopidogrel alone or in addition to aspirin in post coronary artery bypass surgery patients.
MedLine Citation:
PMID:  19539077     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clopidogrel is recommended with aspirin for patients who undergo coronary artery bypass grafting (CABG) after non-ST elevation myocardial infarctions. Cardiothoracic surgeons widely use clopidogrel in addition to aspirin for post-CABG patients, including those with stable coronary artery disease. The aim of this study was to systematically review the published research to determine whether clopidogrel use after CABG is based on good trial data. Studies reporting safety and/or efficacy data for clopidogrel use with or without aspirin after on- or off-pump CABG were included. Fourteen studies met the inclusion criteria, of which 11 were reported trials and 3 are ongoing trials. Subgroup retrospective analyses of previously reported large trials of patients presenting with acute coronary syndromes (n = 1) or patients with stable coronary artery disease (n = 3) did not show a clear clinical benefit of clopidogrel when given in addition to aspirin after CABG. In contrast, there was a trend toward increased major and minor bleeding after the use of clopidogrel plus aspirin. Two small prospective trials providing data on surrogate end points and 5 small trials involving off-pump CABG patients were not of good quality to draw meaningful conclusions. In conclusion, summarized data based on subgroup analyses, surrogate end points, and observational cohort studies fail to demonstrate a clear beneficial effect of clopidogrel alone or in combination with aspirin on clinical outcomes after CABG.
Authors:
Jigar H Patel; Julie A Stoner; Arthur Owora; Sunil T Mathew; Udho Thadani
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-05-04
Journal Detail:
Title:  The American journal of cardiology     Volume:  103     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-07-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1687-93     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, Cardiovascular Section, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA.
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MeSH Terms
Descriptor/Qualifier:
Aspirin / therapeutic use*
Coronary Artery Bypass*
Coronary Restenosis / prevention & control*
Drug Therapy, Combination
Electrocardiography
Humans
Myocardial Infarction / surgery*
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Care / methods*
Ticlopidine / analogs & derivatives*,  therapeutic use
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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