1. In a cohort of patients with myocardial infarctions, dual anti-platelet therapy before a coronary artery bypass grafting procedure has no effect on postoperative outcomes.
Evidence Rating Level: 2 (Good)
Coronary artery bypass grafting (CABG) is used as a treatment for some patients with acute coronary syndrome (ACS_. The basis of ACS treatment is dual antiplatelet therapy (DAPT) usually with aspirin and clopidogrel. However, with a CABG, there is increased risk of bleeding after the procedure which contrasts its long-term benefits. Therefore, antiplatelet therapies must be chosen carefully, balancing these two risks. Therefore, this prospective cohort study was designed to evaluate the effects of DAPT on postoperative outcomes in patients with ACS. It included data from 244 patients (mean [SD] age, 60.4 [9.2] years; 70.5% men). 124 of the participants were placed in the aspirin group, who were treated with 80mg of aspirin daily till before surgery. 120 participants were placed in the DAPT group who received 80mg of aspirin daily and 75mg of clopidogrel daily until the day before the surgery; they also received 600mg of clopidogrel as a loading dose at the time of admission. The primary outcome measured was assessment of postoperative bleeding, intraoperative and postoperative blood transfusions, cardio-bypass and cross-clamp There were no statistically significant differences between the two groups in any of the primary outcomes. Secondary outcomes included assessment of mortality, cerebrovascular accident (CVA), length of hospitalization and stay in cardiac surgery intensive care unit, ejection fraction rate, hospital costs and need for readmission, re-angiography, re-PCI and CABG at 6-month follow-up, recurrence, and occurrence of stroke or death. Similarly, after completing multivariate logistic regression tests, there were no significant differences between the two groups for any secondary outcomes. The study concluded that DAPT with aspirin and clopidogrel before CABG does not have any effect on postoperative outcomes when compared to mono antiplatelet therapy with aspirin. Therefore, given the role of DAPT in preventing ischemic events in ACS patients, it recommended utilizing DAPT over monotherapy in patients undergoing CABG.
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