Balancing the benefit and risk of oral antiplatelet agents in coronary artery bypass surgery.
Concern about possible hemorrhagic complications arising from use of oral antiplatelet agents in immediate proximity to coronary artery bypass graft (CABG) surgery leads many clinicians to avoid or discontinue these agents preoperatively. Recent evidence suggests that aspirin and clopidogrel can be used with relative safety in the preoperative period; dual antiplatelet therapy in the 5 days immediately preceding CABG surgery results in a moderate and variable increase in the risk of procedural bleeding. This modest hemorrhagic risk may be acceptable, given the clinical benefits of sustained antiplatelet therapy in preventing graft occlusion and ischemic complications pre- and post-CABG. Because the bleeding risk with aspirin is dose dependent, use of a low dose is preferred post-CABG.
Cannon
Christopher P
CP
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA. cpcannon@partners.org
Mehta
Shamir R
SR
Aranki
Sary F
SF
D000284:Administration, Oral; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000209:etiology; D018570:Risk Assessment; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin