eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2013
vol. 10
 
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abstract:

Aspirin versus clopidogrel after surgical offpump coronary revascularization – a prospective, randomized, head-to-head pilot trial

Grzegorz Suwalski
,
Magdalena Banach
,
Radosław Smoczyński
,
Jakub Mróz
,
Leszek Gryszko
,
Przemysław Szałański
,
Karol Krawczyk
,
Piotr Hendzel

Kardiochirurgia i Torakochirurgia Polska 2013; 10 (1): 8–13
DOI: https://doi.org/10.5114/kitp.2013.34297
Online publish date: 2013/04/05
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Background: Postoperative clopidogrel use after surgical coronary revascularization may provide short- and long-term reduction of risk of negative cardiovascular events. However, there are not enough data from prospective randomized trials comparing head-to-head monotherapy with either aspirin or clopidogrel.

Aim of the study: The aim of the study was to evaluate the safety and effectiveness of aspirin or clopidogrel use in patients after elective coronary artery bypass grafting.

Material and methods: The study involved 50 patients who were referred for elective off-pump coronary artery bypass grafting (OPCAB). Preoperatively patients were randomized to postoperative antiplatelet treatment with either aspirin (150 mg per day) or clopidogrel for 6 months (75 mg per day). After 6 months all patients were turned to aspirin. In all patients platelet function on aspirin was checked before surgery. After 1, 6 and 12 months in all cases follow-up was collected in terms of any adverse events.

Results: During follow-up 26 negative events occurred, including repeated revascularization, stroke and bleeding. In the clopidogrel arm cumulative risk of negative events was significantly lower (14%) in comparison to the aspirin group (25%, p < 0.05). In patients with preoperative persistent platelet function on aspirin the highest cumulative event risk was observed (35%). The lowest cumulative event risk was observed in aspirin responders randomized to the clopidogrel arm (2%). 

Conclusions: Clopidogrel therapy provided for 6 months after OPCAB instead of the standard aspirin protocol may reduce the risk of negative adverse cardiovascular events. Occurrence of preoperative persistent platelet function on aspirin is related to worse 1-year outcome after off-pump coronary revascularization.
keywords:

coronary artery bypass grafting, antiplatelet therapy
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