A feasibility study of the safety and efficacy of a combined clopidogrel and aspirin regimen following off-pump coronary artery bypass grafting.
OBJECTIVE
Effective antiplatelet therapy may decrease the risk of complications following off-pump coronary artery bypass surgery (CABG). We prospectively evaluated the safety and early efficacy of a combined regimen of clopidogrel and aspirin starting immediately after off-pump CABG.


METHODS
One hundred thirty-five consecutive off-pump CABG patients received clopidogrel (75 mg/day) and aspirin (325 mg/day) orally or initially through a nasogastric tube for 3 months, commencing within 6 hours of surgery. Additionally, heparin (10,000 IU/day) was given subcutaneously during the first 4 postoperative days. Clinical events, including death, myocardial infarction (MI), reintervention, angiographically documented graft occlusion, stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and hemorrhagic events, were recorded. All patients were followed up for 3 months.


RESULTS
Thirteen of 135 off-pump CABG patients had treatment discontinued before discharge because of refractory atrial fibrillation requiring warfarin sodium (Coumadin) (6 patients), gastrointestinal bleeding (1 patient), DVT (1 patient), PE (1 patient), and death (4 patients). The remaining patients were followed up for 3 months. At 1 month, the incidences of the following events were: 3.0% cerebrovascular accidents (3 strokes and 1 transient ischemic attack), 3.0% MI, 0.7% DVT, and 0.7% hemothorax. At 3 months, no additional events had occurred except for 1 patient developing DVT and 2 additional patients developing MI. Coronary angiography was indicated in these last 2 patients. All grafts were found to be patent. However, a native vessel required percutaneous intervention (stenting) in one of these patients.


CONCLUSIONS
Early administration of a combined regimen of clopidogrel and aspirin following off-pump CABG is safe and is associated with a relatively low incidence of major adverse cardiac events, bleeding, PE, and DVT. Consequently, its routine administration after off-pump CABG is recommended.
Shennib
Hani
H
Division of Cardiothoracic Surgery, Montreal General Hospital, Montreal, Quebec, Canada. hani.shennib@muhc.mcgill.ca
Endo
Munemoto
M
Benhameid
Osama
O
D000925:Anticoagulants / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D020246:Venous Thrombosis / Q000209:etiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin