title: Effect of clopidogrel use post coronary artery bypass surgery on graft patency.
abstract: BACKGROUND
  Clopidogrel use post coronary artery bypass grafting (CABG) has become more popular under the assumption that it improves graft patency. The purpose of this sub-analysis from the Randomized On and Off-Pump Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG to improve graft patency when added to standard aspirin therapy.
  
  
  METHODS
  The ROOBY trial was a multi-center, randomized, controlled clinical trial that compared on-pump versus off-pump coronary artery bypass grafting (CABG). Clopidogrel use post CABG was left at the discretion of the operator. Detailed data regarding the use and timing of clopidogrel post CABG were collected prospectively, along with 1-year angiograms to evaluate graft status.
  
  
  RESULTS
  Of the 2,203 subjects undergoing CABG, 953 patient records had complete clopidogrel use and 1-year angiographic data. Of these, 345 (36.2%) received clopidogrel post CABG prior to discharge. Compared with patients with no post-CABG clopidogrel use, baseline characteristics were similar for the clopidogrel group except for the following: lower preoperative aspirin use (80.2% vs 86.7%, p = 0.009); higher preoperative clopidogrel use (23.5% vs 14.0%, p < 0.001), less on-pump (35.9% vs 55.9%, p < 0.0001); and lower endoscopic vein harvesting (30.8% vs 42.5%, p < 0.001) rates. Overall 1-year graft patency rates were not different between the clopidogrel and no-clopidogrel groups (86.5% vs 85.3%, p = 0.43). Multivariable analyses did not alter these findings.
  
  
  CONCLUSIONS
  This study suggests that routine post-CABG clopidogrel use may not translate to improved 1-year graft patency. Future studies appear warranted to better define the role of more aggressive antiplatelet therapy post CABG on graft patency and clinical outcomes.
authors.affiliation: Greater Los Angeles VA Medical Center, Los Angeles, California. Electronic address: ebrahimi@ucla.edu.
authors.forename: Ramin
authors.initials: R
authors.lastname: Ebrahimi
authors.affiliation: The Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Faisal G
authors.initials: FG
authors.lastname: Bakaeen
authors.affiliation: Greater Los Angeles VA Medical Center, Los Angeles, California.
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Uberoi
authors.affiliation: Greater Los Angeles VA Medical Center, Los Angeles, California.
authors.forename: Abbas
authors.initials: A
authors.lastname: Ardehali
authors.affiliation: Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Baltz
authors.affiliation: Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Brack
authors.initials: B
authors.lastname: Hattler
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California; Zablocki VA Medical Center, Milwaukee; and Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: G Hossein
authors.initials: GH
authors.lastname: Almassi
authors.affiliation: Zablocki VA Medical Center, Milwaukee; and Medical College of Wisconsin, Milwaukee, Wisconsin; VA Palo Alto Health Economics Resource Center, Menlo Park, California.
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Medical Center, Perry Point, Maryland.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Collins
authors.affiliation: Eastern Colorado Health Care System, Department of Veterans Affairs, Denver, Colorado; Department of Surgery, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Northport VA Medical Center, Northport, New York.
authors.forename: A Laurie
authors.initials: AL
authors.lastname: Shroyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077144:Clopidogrel; D017023:Coronary Angiography / Q000379:methods; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects / Q000379:methods; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004502:Education, Medical, Continuing; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D012016:Reference Values; D012044:Regression Analysis; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: 23