Key result
VKA plus clopidogrel shows no difference in 6-month bleeding vs VKA plus aspirin after CABG-valve surgery.
Why the study?
The optimal antithrombotic therapy following combined coronary artery bypass graft (CABG) and surgical valve replacement (SVR) surgery remains unclear.
Does vitamin K antagonist plus clopidogrel reduce bleeding compared to vitamin K antagonist plus aspirin in patients following combined CABG and SVR?
Cohort (n=629)
No
Does vitamin K antagonist plus clopidogrel reduce bleeding compared to vitamin K antagonist plus aspirin in patients following combined CABG and SVR?
There were no significant differences in bleeding or ischemic events at 6 months when prescribing either aspirin or clopidogrel in addition to a vitamin K antagonist following combined CABG and surgical valve replacement.
No difference seen in bleeding or events; observational data leave open optimal VKA-based regimen after combined CABG/valve surgery.
The optimal antithrombotic therapy following combined coronary artery bypass graft (CABG) and surgical valve replacement (SVR) surgery remains unclear. The aim of this single-center, retrospective cohort study was to assess the safety and effectiveness of a vitamin K antagonist (VKA) plus either aspirin or clopidogrel in patients following combined CABG and SVR. The primary endpoint was the occurrence of bleeding within six months. The secondary endpoint was the occurrence of CV death, stroke, acute coronary syndrome (ACS), or valve dysfunction. Outcomes were identified by pre-specified ICD codes. A total of 629 patients were included in the analysis, with 583 patients receiving aspirin and 46 patients receiving clopidogrel. Bleeding occurred in 1.7% of patients receiving aspirin and in 0% of patients receiving clopidogrel (p = 0.99). CV death, stroke, ACS, or valve dysfunction occurred in 3.1% of patients receiving aspirin and 4.3% of patients receiving clopidogrel (p = 0.65). In this study, there were no differences in the safety or effectiveness of a VKA plus either aspirin or clopidogrel following combined CABG and SVR.
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Zieminski et al. (2023) conducted a cohort in Concomitant coronary artery disease and valvular heart disease requiring combined CABG and SVR (n=629). Vitamin K antagonist plus clopidogrel vs. Vitamin K antagonist plus aspirin was evaluated on Occurrence of bleeding within six months (p=0.99). Vitamin K antagonist plus clopidogrel did not significantly differ from vitamin K antagonist plus aspirin regarding bleeding within 6 months following combined CABG and surgical valve replacement.
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