title: Use of aspirin and clopidogrel after coronary artery bypass graft surgery.
abstract: OBJECTIVE
  To evaluate the evidence for the use of dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following coronary artery bypass graft (CABG) surgery.
  
  
  METHODS
  Literature was accessed through PubMed (1950-November 2011), EMBASE (1976-November 2011), and the Cochrane databases using the terms clopidogrel and coronary artery bypass graft. Citations from available articles were used for additional references and ClinicalTrials.gov was accessed for abstracts of ongoing studies.
  
  
  METHODS
  Peer-reviewed studies that evaluated DAPT use after CABG surgery in adult humans were assessed for inclusion.
  
  
  RESULTS
  Four randomized clinical trials evaluating surrogate end points and 9 studies (3 subgroup analyses, 6 observational) evaluating clinical outcomes were reviewed. Three clinical trials assessing surrogate end points failed to demonstrate an improvement in graft patency with DAPT use, while 1 clinical trial found an increase in graft patency. As for clinical outcomes, 1 subgroup analysis demonstrated that the benefit of DAPT post-CABG after a non-ST-elevation acute coronary syndrome diminished following surgery, while an observational study demonstrated a trend toward decreased mortality. In post-CABG patients who did not experience acute coronary syndrome, 2 subgroup analyses proved inconclusive and an observational study found DAPT use to be associated with reducing in-hospital mortality, while another observational study was not associated with reduced long-term mortality. Three observational studies in off-pump CABG patients showed that DAPT use was feasible.
  
  
  CONCLUSIONS
  Evidence for DAPT use following CABG is limited to subgroup analyses, observational studies, and trials with surrogate end points. The majority of clinical trials have failed to demonstrate an improvement in graft patency with DAPT. Current evidence does not support the use of DAPT to improve graft patency, and more evidence from randomized controlled trials assessing clinical outcomes is necessary to make definitive recommendations.
authors.affiliation: College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA. nksdeleon@gmail.com
authors.forename: Noelle
authors.initials: N
authors.lastname: de Leon
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000379:methods / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin