Abstract 4355: Influence of Clopidogrel and Acetylsalicyclic Acid Versus Acetylsalicyclic Acid Alone on Early Outcome After Off-pump Coronary Artery Bypass Surgery
Background: Patients undergoing off-pump coronary artery bypass (OPCAB) are known to be hypercoagulable in the early postoperative phase. Clopidogrel (CLP) has been used by many surgeons in association with acetylsalicylic acid (ASA) to alleviate this potential problem. The efficacity of this combination is not known.
Aims of the study: To compare at one year follow-up the influence of the use of CLP-ASA vs ASA alone in OPCAB patients on the occurrence of major adverse cardiac events (MACE).
Methods: We used our prospective data base of 1200 consecutive OPCAB patients (956 men and 244 women) operated between September 1996 and October 2005 representing 98% of all coronary revascularizations during the same time frame. Follow-up was complete in 97% of the cohort. Average follow-up was 64±35 months. CLP (75 mg) was started on day #1 without bolus and kept 3 months postoperatively in 34% of the cohort. All patients received ASA (80 mg).
Results: CLP patients were older (p=0.02), had a lower left ventricular ejection fraction (p<0.01), were more frequently diabetic (p=0.04), hypertensive (p<0.01), were more often on CLP preoperatively (p<0.01), and exposed to antifibrinolytic drugs during surgery. Patients on ASA only had a higher prevalence of recent MI (p=0.04), tobacco use (p<0.01), and previous coronary surgery (p=0.01). Thirty-day mortality (p=0.34) and prevalence of perioperative myocardial infarction (MI) (p=1.0) were similar in both groups. Blood loss (p>0.01), transfusions (p<0.01), were more frequent in CLP group. Prevalence of CVA-TIA was 1.1% and 0.5% for ASA vs ASA-CLP groups respectively (p=0.75). One-year survival (p=0.1) and MACE free survival (p=0.7) including new MI and new need for revascularization was similar in both groups.
Conclusion: CLP in combination to ASA did not change the outcome of OPCAB patients. CLP patients were more frequently exposed to CLP before surgery explaining the higher prevalence of transfusion and blood losses.