Abstract 4769: Aspirin and Clopidogrel Use in Early Postoperative Period Following On-Pump and Off-Pump Coronary Artery Bypass Grafting
Preoperative clopidogrel use increases the risk of bleeding, but the impact of early postoperative clopidogrel use has not been studied. We hypothesized that early postoperative use of clopidogrel in addition to perioperative aspirin reduces mortality without increase in bleeding, compared to aspirin alone, in on-pump and off-pump coronary artery bypass grafting (CABG). We conducted a retrospective analysis of 15,117 adults who received perioperative aspirin, with or without clopidogrel given within 2 days after CABG, at academic medical centers participating in the University HealthSystem Consortium in 2003–2006. In-hospital mortality, 30-day readmission, ischemic or thrombotic events, and bleeding events were compared between the two groups via logistic regression that controlled for propensity of clopidogrel use. Combined aspirin and clopidogrel were used in 3,268 patients (22%). Compared to aspirin alone, aspirin plus clopidogrel was associated with reduction in in-hospital mortality (1.0% vs. 1.8%; adjusted OR: 0.54; 95% CI: 0.31– 0.93), in-hospital mortality or 30-day readmission (8.1% vs. 8.5%; 0.85; 0.69 – 1.05), and bleeding events (4.2% vs. 5.2%; 0.72; 0.54 – 0.94). Ischemic or thrombotic events were not different (1.3% vs. 1.5%; 1.19; 0.81–1.75). The relative effect of combined use did not differ significantly between on-pump and off-pump CABG (Figure⇓). Early postoperative clopidogrel use in addition to aspirin appears safe and more beneficial compared with perioperative aspirin alone, in both on-pump and off-pump CABG. Randomized controlled trials are warranted to confirm our findings.