Key result
Dual antiplatelet therapy before CABG in patients with ACS did not increase mortality or ischemic events but significantly increased bleeding, reoperation, and length of stay.
Why the study?
It remained uncertain whether dual antiplatelet therapy with aspirin and clopidogrel should be continued until coronary artery bypass grafting in patients with acute coronary syndrome.
Does continuing DAPT with aspirin and clopidogrel until CABG affect mortality, ischemic events, and bleeding in patients with ACS?
Meta-Analysis
Does continuing DAPT with aspirin and clopidogrel until CABG affect mortality, ischemic events, and bleeding in patients with ACS?
Answers are grounded in this paper and cite their sources.
Continuing DAPT until CABG in ACS patients does not increase mortality or ischemic events but is associated with increased bleeding, reoperation, and longer hospital stays.
INTRODUCTION: Currently, the basis of acute coronary syndrome (ACS) therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor antagonists. Therefore, the aim of the present systematic review is to answer that should DAPT with Aspirin and clopidogrel be continued until coronary artery bypass grafting (CABG) in patients who have ACS? METHODS: The search for relevant studies in the present meta-analysis is based on three approaches: A) systematic searches in electronic databases, B) manual searches in Google and Google Scholar, and C) screening of bibliography of related original and review articles. The endpoints included mortality rate, myocardial infarction (MI), cerebrovascular accident (CVA), reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion after CABG. RESULTS: After the initial screening, 41 articles were studied in detail, and finally the data of 15 studies were included in the meta-analysis. DAPT before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events, but increases reoperation, re-exploration, length of ICU, and hospital stay. Chest tube drainage and blood product transfusion rate significantly increased in the DAPT group compared to the control group (non-antiplatelet or Aspirin alone). Increase in chest tube drainage and blood product transfusion rate indicates an increase in bleeding, so increase in reoperation, re-exploration to control bleeding, and, subsequently, increase in the length of ICU and hospital stay are expected. CONCLUSIONS: DAPT with Aspirin and clopidogrel before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events despite more bleedings, and it may be suggested before CABG for better graft patency.
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Sadeghi et al. (2020) conducted a meta-analysis in Acute coronary syndrome (ACS). Dual antiplatelet therapy (Aspirin and clopidogrel) vs. Non-antiplatelet or Aspirin alone was evaluated on Mortality rate, myocardial infarction, cerebrovascular accident, reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion. Dual antiplatelet therapy before CABG in patients with ACS did not increase mortality or ischemic events but significantly increased bleeding, reoperation, and length of stay.
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