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Published on: September 15, 2023

Use of aspirin versus clopidogrel plus aspirin after coronary artery bypass graft surgery

Saurabh Sanon1, Vei-Vei Lee, MacArthur Elayda

  • 1Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|December 18, 2008
PubMed

Insights

Dual anti-platelet therapy with aspirin and clopidogrel did not improve survival compared to aspirin alone in patients after coronary artery bypass graft surgery. This finding held true at 4-year follow-up in this observational study.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Dual anti-platelet therapy (DAPT) with aspirin and clopidogrel is used to prevent thrombotic events.
  • Its benefit in patients after coronary artery bypass graft (CABG) surgery is not fully established.
  • Saphenous vein graft (SVG) failure is a concern after CABG.

Purpose of the Study:

  • To evaluate the long-term survival benefit of DAPT versus aspirin monotherapy in patients post-CABG.
  • To assess the association of DAPT with survival outcomes after CABG surgery.

Main Methods:

  • Retrospective observational study of 4297 patients undergoing CABG.
  • Patients were grouped by discharge medication: aspirin only or aspirin plus clopidogrel.
  • Statistical analysis included Cox regression and propensity score matching.

Main Results:

  • Unadjusted 4-year survival was similar between the aspirin-only (88.8%) and aspirin-plus-clopidogrel (87.9%) groups.
  • Adjusted Cox regression analysis showed no significant survival benefit for DAPT (OR 1.055, P = .72).
  • Propensity score-matched analysis also revealed no significant difference in survival between the groups (OR 0.996, P = .98).

Conclusions:

  • In this study population, aspirin plus clopidogrel did not offer a survival advantage over aspirin alone up to 4 years post-CABG.
  • DAPT at hospital discharge was not associated with improved survival in patients after CABG.
  • These findings suggest that aspirin monotherapy may be sufficient for long-term survival in this patient group.

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