Source: Pharmacotherapy  |  Posted 4 years ago

By Danny Kucharsky

NEW ORLEANS, LA -- March 28, 2007 -- Use of clopidogrel in addition to aspirin is safe in terms of bleeding complications among patients undergoing off-pump coronary artery bypass graft (CABG) surgery, finds a study presented here March 27[^]th[] at the 56[^]th[] annual scientific session of the American College of Cardiology (ACC).

The retrospective study aimed to determine safety issues in the use of clopidogrel and ASA versus ASA alone after off-pump CABG, said lead investigator Mital Sheth, MD, professor, department of medicine, division of cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.

Currently, about 20% of cardiac bypass surgeries are performed off pump, he noted, but there is concern about a lack of platelet inhibition as a result of this procedure. As well, trials of clopidogrel use in off-pump procedures to date have shown conflicting results.

The study used the University Health Consortium database, which contains information from more than 90 institutions. Complete records for all 7,326 patients undergoing off-pump CABG between 2000 and 2005 were identified, with 3,512 receiving aspirin and 3,814 receiving the combination of aspirin plus clopidogrel. Cardiac complications, stroke, hemorrhage, gastrointestinal hemorrhage, pulmonary embolism and reopening of surgical site were tracked.

After adjustments were made for age, race and gender, there was no statistically significant increase in stroke (OR = 0.99, []P[] = .98); hemorrhage (OR = 1.05, []P[] = .62) and gastrointestinal hemorrhage (OR=1.18, []P[] = .45) in the patients given the combination.

Overall, for patients undergoing off-pump CABG, postoperative use of clopidogrel in addition to aspirin is safe in terms of bleeding complications and may provide clinical benefit, Dr. Sheth said.

The absolute event rate for complications in patients treated with aspiring or aspirin plus clopidogrel was low. In addition, there was a significant reduction in the rate of readmissions among patients taking aspirin, he said

Although the study had a large sample size, Dr. Sheth cautioned that it was limited by being a retrospective, nonrandomised study. He said further prospective studies are required to assess this treatment strategy, particularly for long-term benefit.

[Presentation title: Safe Use of Clopidogrel and Aspirin Anti-Platelet Therapy After Off Pump Coronary Artery Bypass Graft Surgery. Abstract 1027-18]