title: Use of antiplatelet drugs after cardiac operations.
abstract: Unfortunately, venous bypass grafts still have a prominent role in operative coronary revascularization (coronary artery bypass graft [CABG]). Venous grafts develop pathologically occlusive disease that limits the effectiveness of CABG, and antiplatelet drugs following operation may limit this problem. The types and indications of antiplatelet drugs following CABG generate some controversy in the recent literature. This review surveys relevant evidence about the use of antiplatelet drugs following CABG to identify the controversial issues, define appropriate questions, and attempt to provide evidence-based interventions that may be helpful in limiting graft occlusion after CABG. Evidence suggests that, in most CABG patients, dual antiplatelet drugs (aspirin and clopidogrel), given after operation, minimizes early (within 1 year) graft failure and improves intermediate-term outcomes, better than single antiplatelet therapy with aspirin alone. There are gaps in the knowledge base that supports this contention, and future clinical trials will likely augment or alter this recommendation.
authors.affiliation: Division of Cardiothoracic & Vascular Surgery, Chandler Medical Center, University of Kentucky, Lexington, Kentucky. Electronic address: ferraris@uky.edu.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.affiliation: Division of Cardiothoracic & Vascular Surgery, Chandler Medical Center, University of Kentucky, Lexington, Kentucky.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Bolanos
mesh_terms: D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: coronary artery bypass; coronary artery bypass grafting; dual antiplatelet therapy; graft occlusion; platelet aggregation inhibitors; saphenous vein grafts