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Synergizing Antegrade Endoscopic with Bridging Vein Harvesting for Improvement of Great Saphenous Vein Graft Quality from the Lower Leg
Published on: November 19, 2019
Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a
1Department of Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, The People's Republic of China.
Insights
Adding clopidogrel to aspirin therapy significantly improves saphenous vein graft patency at 3 months after coronary artery bypass grafting (CABG). This combination therapy offers a promising strategy for enhancing early graft survival post-CABG.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Saphenous vein graft occlusion is a significant complication following coronary artery bypass grafting (CABG).
- Early post-operative graft patency is crucial for patient outcomes.
- Aggressive antiplatelet therapy is being investigated to improve graft patency.
Purpose of the Study:
- To compare the efficacy of aspirin plus clopidogrel versus aspirin alone in preventing saphenous vein graft occlusion.
- To evaluate the effect of dual antiplatelet therapy on graft patency at 3 months post-CABG.
Main Methods:
- A randomized trial involving 249 patients undergoing elective CABG.
- Patients received either aspirin plus clopidogrel (AC group) or aspirin alone (A group).
- Saphenous vein graft patency was assessed using 64-slice multislice computed tomography angiography (MSCTA) at 3 months.
Main Results:
- Saphenous vein graft patency was significantly higher in the AC group (91.6%) compared to the A group (85.7%) at 3 months (p=0.043).
- Combined antiplatelet therapy (aspirin plus clopidogrel) was independently associated with increased venous graft patency.
- No significant differences in major adverse cardiac-related events were observed between the groups.
Conclusions:
- Aspirin plus clopidogrel demonstrates superior short-term efficacy in maintaining saphenous vein graft patency after CABG compared to aspirin alone.
- Dual antiplatelet therapy represents a potential strategy to improve early outcomes in CABG patients.
- Further long-term studies are warranted to assess the sustained benefits and safety of this regimen.
Objectives:
We sought to evaluate the effect of aspirin plus clopidogrel versus aspirin alone on saphenous vein graft occlusion at 3 months after coronary artery bypass grafting (CABG).
Background:
Prevalence of graft occlusion is high after CABG. Aggressive antiplatelet therapy is expected to improve early post-operative graft patency.
Methods:
From December 2007 through December 2008, 249 consecutive patients undergoing elective CABG at Fuwai Hospital were randomly assigned to 2 groups: 124 received aspirin (100 mg) plus clopidogrel (75 mg) daily (AC group), and 125 received aspirin (100 mg) alone daily (A group). Antiplatelet therapies were initiated when post-operative chest tube drainage was ≤ 30 cc/h for 2 h. All participants were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis at 3 months post-operatively. Generalized estimating equations analysis was used to determine predictors of graft patency.
Results:
One participant, from group A, died before 3-month follow-up. Of the remaining 248 patients, 224 (90.3%) underwent MSCTA. Participants had similar pre-operative and intraoperative characteristics at baseline. No significant differences were observed in intraoperative transit-time flow measurement findings or major adverse cardiac-related events. Three-month MSCTA follow-up revealed that saphenous vein graft patency was 91.6% (219 of 239) in the AC group versus 85.7% (198 of 231) in the A group (p = 0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency (p = 0.045).
Conclusions:
Aspirin plus clopidogrel is more effective in venous graft patency than aspirin alone in the short term after CABG, but further, long-term study is needed. (The Clopidogrel and Aspirin After Surgery for Coronary Artery Disease; NCT00776477).
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