title: Use of clopidogrel post-coronary artery bypass surgery in canadian patients with acute coronary syndromes.
abstract: BACKGROUND
  Randomized trials have established the efficacy of clopidogrel in acute coronary syndromes (ACS). The benefit of clopidogrel has also been observed in the subgroup of ACS patients who subsequently undergo coronary artery bypass surgery (CABG); however, this therapy is discontinued preoperatively and the frequency with which clopidogrel is restarted post-CABG is unknown.
  
  
  METHODS
  We examined the pattern of clopidogrel use in the Canadian Global Registry of Acute Coronary Events (GRACE), GRACE2, and CANRACE (2003-2008) post-CABG ACS patients. We stratified the patients according to whether they underwent CABG during their index hospitalization for ACS and whether they were prescribed clopidogrel at discharge.
  
  
  RESULTS
  Among those patients in whom clopidogrel status at discharge was known, 5904 (60%) of 9841 were discharged from hospital on clopidogrel. Use of clopidogrel at discharge was observed in 2222 (40.8%) of 5443 patients who were medically managed (ie, did not undergo percutaneous coronary intervention [PCI] or CABG) and in 3585 (90.1%) of 3980 patients who underwent in-hospital PCI. Overall, 455 (3.3%) of 13,776 patients underwent CABG during the index hospitalization; 255 (56%) patients were started on clopidogrel during the first 24 hours, and 66 of these patients (25.9%) were discharged on clopidogrel. In contrast, 5681 (61.3%) of the 9262 patients who did not undergo in-hospital CABG were discharged on clopidogrel.
  
  
  CONCLUSIONS
  Although current guidelines recommend the use of clopidogrel post-CABG in patients with ACS, our observations suggest that only 1 in 4 or 5 Canadian patients are discharged on this therapy.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Krimly
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.forename: J Paul
authors.initials: JP
authors.lastname: DeYoung
authors.forename: Richard
authors.initials: R
authors.lastname: Gallo
authors.forename: Gabriel
authors.initials: G
authors.lastname: Steg
authors.forename: John
authors.initials: J
authors.lastname: Eikelboom
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Keith A A
authors.initials: KA
authors.lastname: Fox
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Mackenzie A
authors.initials: MA
authors.lastname: Quantz
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D000368:Aged; D002170:Canada / Q000453:epidemiology; D006328:Cardiac Catheterization; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods* / Q000592:standards; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine