Interv Akut Kardiol. 2014;13(2):77-85

Dual antiplatelet therapy in patients after surgical revascularization of myocardium

Andrej Myjavec, Miroslav Brtko
Kardiocentrum, Kardiochirugická klinika, LF UK Hradec Králové

Aortocoronary bypass graft surgery with the use of arterial and/or venous grafts is well-established method of cardiac revascularization.

While the long-term patency of arterial grafts is outstanding, venous grafts are burdened with quite a high rate of occlusions, potentially

posing a risk of myocardial infarction, necessity of revascularization and death to the patient. Acetylosalysic acid is indicated in

all patients with ischemic heart disease (in the absence of contraindications). Its early administration is important in order to prevent

venous graft occlusion as well as to affect morbidity and mortality in the patients after the surgical revascularization of myocardium.

Whether dual antiplatelet therapy by adding clopidogrel or ticagrelor or prasugrel to acetylosalysic acid may further improve outcomes

of these patients remains unresolved. The results of the clinical trials and current opinion are presented in this review article. The existing

knowledge on the new P2Y12 receptor antagonists (ticagrelor and prasugrel) is mentioned as well.

Keywords: aortocoronary bypass graft, dual antiplatelet therapy, novel P2Y12 receptor antagonists

Published: May 15, 2014  Show citation

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Myjavec A, Brtko M. Dual antiplatelet therapy in patients after surgical revascularization of myocardium. Interv Akut Kardiol. 2014;13(2):77-85.
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References

  1. Horák J, Šimek S, Kovárník T, Semrád M, Lindner J, Linhart A. Hybridní revaskularizace myokardu - pohled kardiologa. Cor et Vasa 2012; 54(5-6): 269-282. Go to original source...
  2. Mannacio VA, Di Tommaso L, Antignan A, De Amicis V, Vosa C. Aspirin plus clopidogrel for optimal platelet inhibition following off-pump coronary artery bypass surgery: results from the CRYSSA (prevention of Coronary arteRY bypaSS occlusion After off-pump procedures) randomised study. Heart. 2012; 98(23): 1710-5. doi: 10.1136/heartjnl-2012-302449. Epub 2012 Sep 2. Go to original source... Go to PubMed...
  3. Dominik J. Kardiochirurgie. Grada Publishing 1998.
  4. Piana RN, Adams MR, Orford JL, Popma JJ, Adams DH, Goldhaber SZ. Rescue Percutaneous Coronary Intervention Immediately Following Coronary Artery Bypass Grafting. CHEST 2001; 120: 1417-1420. Go to original source... Go to PubMed...
  5. Kolozsvari R, Galajda Z, Ungvari T, et al. Various clinical scenarios leading to development of the string sign of the internal thoracic artery after coronary bypass surgery: the role of competitive flow, a case series. Journal of Cardiothoracic Surgery 2012, 7: 12. http://www.cardiothoracicsurgery.org/content/7/1/12. Go to original source... Go to PubMed...
  6. Sabik JF III. Understanding saphenous vein graft patency. Circulation.2011; 124: 273-275. doi: 10.1161/CIRCULATIONAHA.111.039842. Go to original source... Go to PubMed...
  7. Sun JC, Teoh KH, Lamy A, et al. Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graf occlusion: the preoperative aspirin and postoperative antiplatelets in coronary artery bypass grafting study. Am Heart J 2010; 160: 1178-1184. Go to original source... Go to PubMed...
  8. Goldman S, Copeland J, Moritz T, et al. Starting aspirin therapy after operation. Effects on early graft patency. Department of Veterans Affairs Cooperative Study Group. Circulation 1991; 84(2): 520-526. Go to original source... Go to PubMed...
  9. Mangano DT, for the Multicenter Study of Perioperative Ischemia Research Group. Aspirin and mortality from coronary bypass surgery. N Engl J Med 2002; 347: 1309-1317. Go to original source... Go to PubMed...
  10. Dunning J, Versteegh M, Fabbri A, et al. on behalf of the EACTS Audit and Guidelines Committee. Guidelines on antiplatelet and anticoagulation management in cardiac surgery. EJCTS 2008; 34: 73-92. Go to original source... Go to PubMed...
  11. Wijns W, Kolh P, Danchin N, et al. Guidelines on myocardial revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association for Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal 2010; 31: 2501-2555. doi: 10.1093/eurheartj/ehq277. Go to original source... Go to PubMed...
  12. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. http://circ.ahajournals.org/content/124/23/e652.
  13. Widimský P, Moťovská Z, Vaněk T, Línková H, Kočka V. Protocols of Antithrombotic therapy in a University Cardiocenter. Cor et Vasa 55 (2013), e201-206. http://www.sciencedirect.com/science/article/pii/S0010865013000295. Go to original source...
  14. Fox KA, Mehta SR, Peters R, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the clopidogrel in unstable angin, a to prevent recurrent ischemic events (CURE) trial. Circulation 2004; 110: 1202-1208. Go to original source... Go to PubMed...
  15. Bhatt DL, Fox KAA, Hacke W, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354: 1706-1717. Go to original source... Go to PubMed...
  16. Steinhbl SR, Berger PB, Mann JT 3rd, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention. JAMA 2002; 288: 2411-2420. Go to original source... Go to PubMed...
  17. S?rensen R, Abildstr?m SZ, Hansen PR, et al. Efficacy of Post-Operative Clopidogrel Treatment in Patients Revascularized With Coronary Artery Bypass Grafting After Myocardial Infarction. JACC 2011; 57(10): 1202-1209. Go to original source... Go to PubMed...
  18. Kim DH, Daskalakis C, Silvestry SC, et al. Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2009; 138: 1377-1384. Go to original source... Go to PubMed...
  19. Gurbuz AT, Zia AA, Vuran AC, Cui H, Aytac A. Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study. Eur J Cardiothoracic Surg 2006; 29: 190-195. Go to original source... Go to PubMed...
  20. Nielsen AB, Bochsen L, Steinbrüchel DA. Hypercoagulability and platelet inhibition after OPCAB: randomized trial with clopidogrel. Scand Cardiovasc J 2007; 41: 325-330. Go to original source... Go to PubMed...
  21. Gao G, Zheng Z, Pi Y, Lu B, Lu J, Hu S. Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery; a single-center randomized controlled trial. J Am Coll Cardiol 2010; 56: 1639-1643. Go to original source... Go to PubMed...
  22. Gao C, Ren C, Li D, Li L. Clopidogrel and aspirin versus clopidogrel alone on graft patency after coronary artery bypass grafting. Ann Thorac Surg 2009; 88: 59-62. Go to original source... Go to PubMed...
  23. Sanon S, Lee VV, Elayda M, Wilson JM. Use of aspirin versus clopidogrel plus aspirin after coronary artery bypass graf surgery. Clinical and Applied Thrombosis/Hemostasis 2009; 15: 540-544. Go to original source... Go to PubMed...
  24. Kulik A, Le May MR, Voisine P, et al. Aspirin plus clopidogrel versus apsirin alone after conorary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE trial). Circulation 2010; 122: 2680-2687. Go to original source... Go to PubMed...
  25. Ibrahim K, Tjornsland O, Halvorsen D, et al. Effect of clopidogrel on midterm graft patency following off-pump coronary revascularization surgery. The Heart Surgery Forum 2006; 9(6): e851-856. Go to original source... Go to PubMed...
  26. Gasparovic H, Petricevic M, Kopjar T, Djuric Z, Svetina L, Biocina B. Dual antiplatelet therapy in patients with aspirin resistance following coronary artery bypass grafting: study protocol for a randomized controlled trial. http://clinicaltrials.gov/ct2/show/NCT01159639?.
  27. Slim AM, Beck R, Conner W. Aspirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG). http://clinicaltrials.gov/ct2/show/NCT01158703?.
  28. Rafiq S, Steinbrüchel D, Johansson P, Kofoed K, Zacho M, Stissing T. ThrombElastoGraphic Haemostatic Status and Antiplatelet Therapy After Coronary Artery Bypass Graft Surgery (TEG-CABG). http://clinicaltrials.gov/ct2/show/NCT01046942?.
  29. Held C, ?senblad N, Bassand JP, et al. Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndromes Undergoing Coronary Artery Bypass Surgery. Results From the PLATO (Platelet Inhibition and Patients Outcomes) Trial. JACC 2011; 57(6): 672-684. Go to original source... Go to PubMed...
  30. Smith PK, Goodnough LT, Levy JH, et al. Mortality Benefit With Prasugrel in the TRITON-TIMI 38 Coronary Artery Bypass Grafting Cohort. JACC 2012; 60(5): 388-396. Go to original source... Go to PubMed...
  31. Gundry SR, Romano MA, Shattuck OH, Razzouk AJ, Bailey LL. Seven year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass. J Thorac Cardiovasc Surg 1998; 115: 1273-1278. Go to original source... Go to PubMed...
  32. Bouchard D, Cartier R. Off-pump revascularization of multivessel coronary artery disease has a decreased myoacardial infarction rate. Eur J Cardiothorac Surg 1998; 14(Suppl I): S20-24. Go to original source... Go to PubMed...
  33. Ivanov J, Borger MA, Tu JV, Rao V, David TE. Mid-term outcomes of off-pump versus on-pump coronary artery bypass graft surgery. Can J Cardiol 2008: 24(4) Go to original source... Go to PubMed...
  34. Williams ML, Muhlbaier LH, Schroder JN, et al. Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass graft. Circulation 2005; 112(Suppl 9): I366-370. Go to original source... Go to PubMed...
  35. Quigley RL, Fried DW, Pym J, Highbloolm RY. Off-pump coronary artery bypass surgery may produce a hypercoagulable patient. The Heart Surgery Forum 2003; 6: 94-98. Go to original source... Go to PubMed...
  36. Kim KB, Lim C, Lee C, et al. Off-pump coronary artery bypass may decrease patency of saphenous vein grafts. Ann Thorac Surg 2001; 72: S1033-1037. Go to original source... Go to PubMed...
  37. Zimmermann N,  Kurt M,  Wenk A,  Winter J,  Gams E, Hohlfeld T. Is cardiopulmonary bypass a reason for aspirin resistance after coronary artery bypass grafting? Eur J Cardiothorac Surg. 2005; 27(4): 606-10. Epub 2005 Jan 19. Go to original source... Go to PubMed...
  38. Wang Z, Gao F, Men J, Ren J, Modic P, Wei M. Aspirin resistance in off-pump coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery 41 (2012) 108-112, doi: 10.1016/j.ejcts.2011.04.021. Go to original source... Go to PubMed...
  39. Plášek J, Homza M, Gumulec J, Ryzí M, Stančík R, Šipula D. Rezistence k antiagregační léčbě: klinická relevance funkčního vyšetření trombocytů. Cor et vasa 2012; 54(9-10): 481-489. Go to original source...
  40. Brtko M, Dušek J. Antithrombotic therapy in patients after valve surgery with special attention to the combination of anticoagulant and antiplatelet therapy. Cor et Vasa 55 (2013): e164-e169. http://www.sciencedirect.com/science/article/pii/S0010865013000118. Go to original source...
  41. Dewilde T, Oirbans T, Verheugt F, et al. The WOEST Trial: First randomised trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting. ESC, Hotline III, Munchen, August 28th, 2012. In: www.clinicaltrialresults.org/...ESC%20 WOEST%202012.ppt.




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