Early dual antiplatelet therapy versus aspirin monotherapy after coronary artery bypass surgery: survival and safety outcomes

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Francisca Almeida Saraiva

    Autor

  • Rui João Gonçalves Cerqueira

    Autor

  • António Sousa Barros

    Autor

  • André Pedro Leite Martins Lourenço

    Autor

  • Joaquim Adelino Correia Ferreira Leite Moreira

    Autor

Participantes de fora da FMUP

  • Rocha-Gomes, JN
  • Moreira, R
  • Ferreira, AF
  • Amorim, MJ
  • Pinho, P

Unidades de investigação

Abstract

BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. METHODS : Single-center retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Survival analysis (median follow-up 9 years) was performed using Kaplan-Meier curves and multivariable Cox regression using propensity score (PS) as a covariate along with DAPT. Bleeding was assessed through red blood cells' (RBC) transfusion, re-exploration of thorax and drainage. RESULTS: We included 351 patients (251 were DAPT). Kaplan-Meier curves showed similar cumulative survival between groups (9y: 75% DA PT vs. 67% ASA, Log-rank P=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95% CI: 0.57-1.51). We found no differences in early mortality (2 DAPT and 1 ASA). Total median cell-saver transfusion (300 mL vs. 250 mL) and the re-exploration of thorax due to bleeding (1.6% vs. 4%) showed no statistical significance either. On the other hand, postoperative total median chest tube drainage was higher in the ASA group (1220 mL DAPT vs. 1320 mL ASA, P=0.034). There was also a lower frequency of DAPT patients requiring RBC transfusions (>= 3 units 4.8% vs. 13%, P=0.009, respectively). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up. CONCLUSIONS: Compared with ASA, DAPT showed a non-significant impact on long-term survival and demonstrated to be a safe option. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.

Dados da publicação

ISSN/ISSNe:
0021-9509, 1827-191X

Journal of Cardiovascular Surgery  Edizioni Minerva Medica S.p.A.

Tipo:
Article
Páginas:
662-672
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 2

Citações Recebidas na Scopus: 3

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Keywords

  • Coronary artery disease; Coronary artery bypass; Aspirin; Clopidogrel; Survival

Financiamento

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