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Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting

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Abstract

Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting (CABG); however, little is known about the safety or efficacy. We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG. We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites. Postoperative antiplatelet therapy was left to physician discretion. Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG. At 30 days, 633 (21 %) patients were taking clopidogrel. Clopidogrel users were more likely to have peripheral vascular (15 vs. 11 %) and cerebrovascular disease (17 vs. 11 %), prior myocardial infarction (MI) (46 vs. 41 %), and off-pump surgery (33 vs. 18 %). Clopidogrel use was associated with statistically insignificant higher graft failure (adjusted odds ratio 1.3; 95 % confidence interval [CI] [1.0, 1.7]; P = 0.05). At 5-year follow-up, clopidogrel use was associated with similar composite rates of death, MI, or revascularization (27 vs. 24 %; adjusted hazard ratio 1.1; 95 % CI [0.9, 1.4]; P = 0.38) compared with those not using clopidogrel. There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG. In this observational analysis, clopidogrel use was not associated with better 5-year outcomes following CABG. There may be better outcomes with clopidogrel among patients having off-pump surgery. Adequately powered randomized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG.

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Conflict of Interest

The PREVENT IV trial was funded by Corgentech Inc., San Francisco, CA. This manuscript was funded by the Duke Clinical Research Institute. Drs. Williams, Ferguson, Mack, Smith, and Alexander are supported in part by grant U01-HL088953 from the National Institutes of Health Cardiothoracic Surgical Trials Network. Dr. Gibson reports research support and consulting with Sanofi Aventis. Dr. Harrington reports research support and consulting with Bristol-Myers Squibb, Gilead Pharmaceuticals, Johnson & Johnson, Merck, Orexigen, and WebMD. Dr. Peterson reports research support from Sanofi, Merck, Lilly, Johnson & Johnson and serves as principal investigator for the Data Coordinating Center for Society of Thoracic Surgeons. Dr. Smith reports serving on the advisory board for Eli Lilly. Dr. Alexander reports research support from Bristol-Myers Squibb, Merck, Pfizer, Regado Biosciences and consultant work for AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Merck, Novartis, Ortho-McNeil-Janssen Pharmaceuticals, and Regado Biosciences. The rest of the authors have no conflict of interests to report.

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Authors and Affiliations

  1. Duke Clinical Research Institute, Durham, NC, USA

    Judson B. Williams, Renato D. Lopes, Gail E. Hafley, C. Michael Gibson, Eric D. Peterson, Rajendra H. Mehta & John H. Alexander

  2. Duke University Medical Center, Durham, NC, USA

    Judson B. Williams, Renato D. Lopes, Eric D. Peterson, Peter K. Smith & John H. Alexander

  3. East Carolina University, Greenville, NC, USA

    T. Bruce Ferguson Jr.

  4. Cardiopulmonary Research Science & Technology Institute, Dallas, TX, USA

    Michael J. Mack

  5. PERFUSE Angiographic Laboratory, Boston, MA, USA

    C. Michael Gibson

  6. Stanford School of Medicine, Stanford, CA, USA

    Robert A. Harrington

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  1. Judson B. Williams
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Correspondence to John H. Alexander.

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Williams, J.B., Lopes, R.D., Hafley, G.E. et al. Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting. J Thromb Thrombolysis 36, 384–393 (2013). https://doi.org/10.1007/s11239-013-0904-1

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  • DOI: https://doi.org/10.1007/s11239-013-0904-1

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