Adding clopidogrel to aspirin after off-pump coronary artery bypass grafting significantly reduced graft occlusion at 3 months compared to aspirin alone (6.9% vs 29.6%; P=0.037).
RCT (n=20)
Does adding clopidogrel to aspirin improve graft patency at 3 months in patients undergoing off-pump coronary artery bypass surgery?
Adding clopidogrel to aspirin after off-pump coronary artery bypass grafting may improve graft patency at 3 months without increasing postoperative bleeding.
Absolute Event Rate: 6.9% vs 29.6%
p-value: p=0.037
OBJECTIVE: : The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. METHODS: : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. RESULTS: : Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. CONCLUSIONS: : Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.
Mujanović et al. (Tue,) conducted a rct in Off-pump coronary artery bypass (OPCAB) grafting (n=20). Clopidogrel and aspirin vs. Aspirin 100 mg alone was evaluated on Graft occlusion at 3 months (p=0.037). Adding clopidogrel to aspirin after off-pump coronary artery bypass grafting significantly reduced graft occlusion at 3 months compared to aspirin alone (6.9% vs 29.6%; P=0.037).