title: Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery.
abstract: We sought to assess the incidence of aspirin resistance after off-pump coronary artery bypass (OPCAB) surgery, and investigate whether clopidogrel can improve aspirin response and be safely applied early after OPCAB surgery. Sixty patients who underwent standard OPCAB surgery were randomized into two groups. One group (30 patients) received mono-antiplatelet treatment (MAPT) with aspirin 100 mg daily and the other group received dual antiplatelet treatment (DAPT) with aspirin 100 mg daily plus clopidogrel 75 mg daily. Platelet aggregations in response to arachidonic acid (PLAA) and adenosine diphosphate (ADP) (PLADP) were measured preoperatively and on days 1 to 6, 8 and 10 after the antiplatelet agents were administered. A PLAA level above 20% was defined as aspirin resistance. Postoperative bleeding and other perioperative variables were also recorded. There were no significant differences between the two groups in baseline characteristics, average number of distal anastomosis, operation time, postoperative bleeding, ventilation time and postoperative hospital stay. However, the incidence of aspirin resistance was significantly lower in the DAPT group than that in the MAPT group on the first and second day after antiplatelet agents were given (62.1% vs. 32.1%, 34.5% vs. 10.7%, respectively, both P < 0.05). There was no significant difference in postoperative complication between the two groups. DAPT with aspirin and clopidogrel can be safely applied to OPCAB patients early after the procedure. Moreover, clopidogrel reduces the incidence of OPCAB-related aspirin resistance.
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China; ; Department of Cardiology, Maanshan people's Hospital, Maanshan, Anhui 243000, China;
authors.forename: Xuezhong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
authors.forename: Xiaoxuan
authors.initials: X
authors.lastname: Gong
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China; ; Department of Cardiology, Jiangning People's Hospital, Nanjing, Jiangsu, China;
authors.forename: Tiantian
authors.initials: T
authors.lastname: Zhu
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China; ; Department of Cardiology, the Second People's Hospital of Changzhou City, Changzhou, Jiangsu, China;
authors.forename: Qiu
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Cardiac-thoracic Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
authors.forename: Yangyang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Cardiac-thoracic Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
authors.forename: Zhijian
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Cardiology, the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
authors.forename: Chunjian
authors.initials: C
authors.lastname: Li
keywords: aspirin; aspirin resistance; clopidogrel; off-pump coronary artery bypass (OPCAB)