Key result
Dual antiplatelet therapy with aspirin and clopidogrel up to the day before CABG in patients with myocardial infarction did not significantly increase in-hospital mortality (OR 4.2) or postoperative bleeding compared to aspirin alone.
Why the study?
DAPT in patients with MI who are candidates for early CABG can affect intraoperative and postoperative outcomes, but its effects up to the day before surgery needed evaluation.
Does dual antiplatelet therapy with aspirin and clopidogrel continued until the day before surgery increase bleeding or worsen outcomes compared to aspirin alone in patients undergoing coronary artery bypass grafting?
Cohort (n=244)
Unblinded
No
Does dual antiplatelet therapy with aspirin and clopidogrel continued until the day before surgery increase bleeding or worsen outcomes compared to aspirin alone in patients undergoing coronary artery bypass grafting?
Odds Ratio: 4.2 (95% CI 0.9–20.5)
Absolute Event Rate: 7.5% vs 1.6%
p-value: p=0.071
Continuing dual antiplatelet therapy with aspirin and clopidogrel until the day before CABG in patients with MI does not significantly increase postoperative bleeding or adverse outcomes compared to aspirin alone.
Supports continuing DAPT to day before CABG without excess bleeding; hypothesis-generating in small observational cohort with wide CIs.
BACKGROUND: Dual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI. METHODS: In this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes. RESULTS: The in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9-20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446). CONCLUSIONS: A 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.
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Sadeghi et al. (2021) conducted a cohort in Myocardial infarction requiring coronary artery bypass grafting (n=244). Dual antiplatelet therapy (Aspirin + Clopidogrel) vs. Aspirin 80 mg/day alone was evaluated on In-hospital mortality (OR 4.2, 95% CI 0.9-20.5, p=0.071). Dual antiplatelet therapy with aspirin and clopidogrel up to the day before CABG in patients with myocardial infarction did not significantly increase in-hospital mortality (OR 4.2) or postoperative bleeding compared to aspirin alone.
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