Document Detail

Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting.
MedLine Citation:
PMID:  23543398     Owner:  NLM     Status:  MEDLINE    
Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting (CABG); however, little is known about the safety or efficacy. We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG. We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites. Postoperative antiplatelet therapy was left to physician discretion. Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG. At 30 days, 633 (21%) patients were taking clopidogrel. Clopidogrel users were more likely to have peripheral vascular (15 vs. 11%) and cerebrovascular disease (17 vs. 11%), prior myocardial infarction (MI) (46 vs. 41%), and off-pump surgery (33 vs. 18%). Clopidogrel use was associated with statistically insignificant higher graft failure (adjusted odds ratio 1.3; 95% confidence interval [CI] [1.0, 1.7]; P = 0.05). At 5-year follow-up, clopidogrel use was associated with similar composite rates of death, MI, or revascularization (27 vs. 24%; adjusted hazard ratio 1.1; 95% CI [0.9, 1.4]; P = 0.38) compared with those not using clopidogrel. There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG. In this observational analysis, clopidogrel use was not associated with better 5-year outcomes following CABG. There may be better outcomes with clopidogrel among patients having off-pump surgery. Adequately powered randomized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG.
Judson B Williams; Renato D Lopes; Gail E Hafley; T Bruce Ferguson; Michael J Mack; C Michael Gibson; Robert A Harrington; Eric D Peterson; Peter K Smith; Rajendra H Mehta; John H Alexander
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  36     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-11-11     Completed Date:  2014-06-23     Revised Date:  2014-11-05    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  384-93     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Aspirin / administration & dosage,  adverse effects
Coronary Angiography*
Coronary Artery Bypass*
Double-Blind Method
Follow-Up Studies
Middle Aged
Myocardial Infarction / mortality,  radiography*,  therapy*
Platelet Aggregation Inhibitors / administration & dosage*,  adverse effects
Postoperative Care*
Ticlopidine / administration & dosage,  adverse effects,  analogs & derivatives*
Grant Support
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin
Comment In:
J Thromb Thrombolysis. 2014 Apr;37(3):249-50   [PMID:  23722714 ]

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

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