Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
1 January 2020
,
Page e61
https://doi.org/10.22037/aaem.v8i1.730
Abstract
Abstract
Introduction: Currently the basis of acute coronary syndrome (ACS) therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor antagonists. Therefore, the aim of the present systematic review is to answer that should DAPT with Aspirin and clopidogrel be continue until coronary artery bypass grafting (CABG) in patients who have ACS?
Methods: The search for relevant studies in the present meta-analysis is based on three approach: A) systematic searches in electronic databases, B) manual searches in Google and Google Scholar and C: screening of bibliography of related original and review articles. The endpoints included mortality rate, myocardial infarction (MI), cerebrovascular accident (CVA), reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion after CABG.
Results: After the initial screening, 41 studies were studied in detail and finally the data of 15 studies were included in the meta-analysis. DAPT before CABG in patients with ACS does not increase rate of mortality, CVA, renal failure, MI, and other cardiac events but increase reoperation, re-exploration, length of ICU and hospital stay. Chest tube drainage and blood product transfusion rate in the DAPT compared to control group (non-antiplatelet or Aspirin alone) significantly increased. Increasement in chest tube drainage and blood product transfusion rate indicates increase in bleeding, so increase in reoperation, re-exploration to control bleeding and subsequently increase in length of ICU and hospital stay is expected.
Conclusions:Â DAPT with Aspirin and clopidogrel before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events despite more bleedings, and it may be suggested before CABG for better graft patency.
- Dual Anti-Platelet Therapy
- Coronary Artery Bypass
- acute coronary syndrome
- Aspirin
- clopidogrel
How to Cite
References
Bertrand ME. When and how to discontinue antiplatelet therapy. European heart journal supplements. 2008;10(suppl_A):A35-A41.
Sabatine MS, Cannon CP, Gibson CM, López-Sendón JL, Montalescot G, Theroux P, et al. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. Jama. 2005;294(10):1224-32.
Chen Z. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366:1607-21.
Gerschutz GP, Bhatt DL. The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study: to what extent should the results be generalizable? American heart journal. 2003;145(4):595-601.
Kremke M, Tang M, Bak M, Kristensen KL, Hindsholm K, Andreasen JJ, et al. Antiplatelet therapy at the time of coronary artery bypass grafting: a multicentre cohort study. European Journal of Cardio-thoracic Surgery. 2013;44(2):e133-e40.
Straus S, Haxhibeqiri-Karabdic I, Grabovica SG, Granov N. A difference in bleeding and use of blood and blood products in patients who were preoperatively on aspirin or dual antiplatelet therapy before coronary artery bypass grafting. Medical Archives. 2018;72(1):31.
Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non–ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation. 2004;110(10):1202-8.
Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? The Annals of thoracic surgery. 2004;78(5):1536-41.
Berger JS, Frye CB, Harshaw Q, Edwards FH, Steinhubl SR, Becker RC. Impact of clopidogrel in patients with acute coronary syndromes requiring coronary artery bypass surgery: a multicenter analysis. Journal of the American College of Cardiology. 2008;52(21):1693-701.
Herman CR, Buth KJ, Kent BA, Hirsch GM. Clopidogrel increases blood transfusion and hemorrhagic complications in patients undergoing cardiac surgery. The Annals of thoracic surgery. 2010;89(2):397-402.
Ebrahimi R, Dyke C, Mehran R, Manoukian SV, Feit F, Cox DA, et al. Outcomes following pre-operative clopidogrel administration in patients with acute coronary syndromes undergoing coronary artery bypass surgery: the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) trial. Journal of the American College of Cardiology. 2009;53(21):1965-72.
Dunning J, Versteegh M, Fabbri A, Pavie A, Kolh P, Lockowandt U, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2008;34(1):73-92.
Ferraris VA, Ferraris SP, Saha SP, Hessel II EA, Haan CK, Royston BD, et al. Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. The Annals of thoracic surgery. 2007;83(5):S27-S86.
Fitchett D, Eikelboom J, Fremes S, Mazer D, Singh S, Bittira B, et al. Dual antiplatelet therapy in patients requiring urgent coronary artery bypass grafting surgery: a position statement of the Canadian Cardiovascular Society. Canadian Journal of Cardiology. 2009;25(12):683-9.
Sistrom CL, Mergo PJ. A simple method for obtaining original data from published graphs and plots. American Journal of Roentgenology. 2000;174(5):1241-4.
Furlan AD, Pennick V, Bombardier C, van Tulder M. 2009 updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine. 2009;34(18):1929-41.
National Heart L, Institute B. Quality assessment tool for observational cohort and cross-sectional studies. Bethesda: National Institutes of Health, Department of Health and Human Services. 2014:103-11.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.
Blasco-Colmenares E, Perl TM, Guallar E, Baumgartner WA, Conte JV, Alejo D, et al. Aspirin plus clopidogrel and risk of infection after coronary artery bypass surgery. Archives of Internal Medicine. 2009;169(8):788-95.
Gielen CL, Bruggemans EF, Stijnen T, Eikenboom J, Tavilla G, Brand A, et al. Stopping antiplatelet medication before coronary artery bypass graft surgery: is there an optimal timing to minimize bleeding? European Journal of Cardio-Thoracic Surgery. 2015;48(4):e64-e70.
Heidari A, Dezfouli FG, Tabatabi K, Mali S, Ahang R, Latifi SM, et al. Combined clopidogrel and aspirin treatment up to surgery dosen’t increase the risk of postoperative blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting. Int J Pharmaceut Res Allied Sci. 2016;5:164-7.
Hekmat K, Menzel C, Kroener A, Schwinger R, Kampe S, Fischer U, et al. The effect of preoperative antiplatelet therapy in coronary artery surgery: blood transfusion requirements for patients on cardiopulmonary bypass. Current medical research and opinion. 2004;20(9):1429-35.
Hongo RH, Ley J, Dick SE, Yee RR. The effect of clopidogrel incombination with aspirin whengiven before coronary artery bypass grafting. Journal of the American College of Cardiology. 2002;40(2):231-7.
Hoxha A, Shehu S, Deveja R, Qirjazi T. Impact of Clopidogrel Loading for Coronarography on Bleeding After Urgent First Time CABG. Medical Archives. 2018;72(5):319.
Leiva-Pons J, Carrillo-Calvillo J, Leiva-Garza J, Loyo-Olivo M, Piña-RamÃrez B, López-Quijano J, et al. Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery. Archivos de cardiologÃa de México. 2008;78(2):178-86.
Miceli A, Duggan SM, Aresu G, de Siena PM, Romeo F, Glauber M, et al. Combined clopidogrel and aspirin treatment up to surgery increases the risk of postoperative myocardial infarction, blood loss and reoperation for bleeding in patients undergoing coronary artery bypass grafting. European Journal of Cardio-Thoracic Surgery. 2013;43(4):722-8.
Ouattara A, Bouzguenda H, Le Manach Y, Léger P, Mercadier A, Leprince P, et al. Impact of aspirin with or without clopidogrel on postoperative bleeding and blood transfusion in coronary surgical patients treated prophylactically with a low-dose of aprotinin. European heart journal. 2007;28(8):1025-32.
Plicner D, Mazur P, Hymczak H, Stoliński J, Litwinowicz R, Drwiła R, et al. Preoperative platelet aggregation predicts perioperative blood loss and rethoracotomy for bleeding in patients receiving dual antiplatelet treatment prior to coronary surgery. Thrombosis research. 2015;136(3):519-25.
Ray JG, Deniz S, Olivieri A, Pollex E, Vermeulen MJ, Alexander KS, et al. Increased blood product use among coronary artery bypass patients prescribed preoperative aspirin and clopidogrel. BMC cardiovascular disorders. 2003;3(1):3.
Von Heymann C, Redlich U, Moritz M, Sander M, Hein OV, Grubitzsch H, et al. Aspirin and clopidogrel taken until 2 days prior to coronary artery bypass graft surgery is associated with increased postoperative drainage loss. The Thoracic and cardiovascular surgeon. 2005;53(06):341-5.
Zhu P, Chen Y, Wang H, Song B. Preoperative antiplatelet drugs on the hemorrhage and allogenic blood transfusion condition after coronary artery bypass graft surgery. Pakistan journal of pharmaceutical sciences. 2018;31(6 (Special)):2819-22.
Leiva-Pons J, Carrillo-Calvillo J, Leiva-Garza J, Loyo-Olivo M, Piña-RamÃrez B, López-Quijano J, et al. Importance of the time for stopping the combined use of aspirin and clopidogrel in patients undergoing coronary artery by-pass graft surgery. Archivos de cardiologia de Mexico. 2008;78(2):178-86.
Cao C, Indraratna P, Ang SC, Manganas C, Park J, Bannon PG, et al. Should clopidogrel be discontinued before coronary artery bypass grafting for patients with acute coronary syndrome? A systematic review and meta-analysis. The Journal of thoracic and cardiovascular surgery. 2014;148(6):3092-8.
Nijjer SS, Watson G, Athanasiou T, Malik IS. Safety of clopidogrel being continued until the time of coronary artery bypass grafting in patients with acute coronary syndrome: a meta-analysis of 34 studies. European heart journal. 2011;32(23):2970-88.
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