Clopidogrel use after myocardial revascularization: prevalence, predictors, and one-year survival rate
Rev. bras. cir. cardiovasc
;
31(2): 106-114, Mar.-Apr. 2016. tab, graf
Artículo
en Inglés
| LILACS
| ID: lil-792646
ABSTRACT
Abstract Introduction:
Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario.Objective:
Identify predictors of clopidogrel following CABG.Methods:
We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG.Results:
At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032).Conclusion:
Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Texto completo:
Disponible
Índice:
LILACS (Américas)
Asunto principal:
Complicaciones Posoperatorias
/
Ticlopidina
/
Inhibidores de Agregación Plaquetaria
/
Puente de Arteria Coronaria
/
Revascularización Miocárdica
Tipo de estudio:
Ensayo Clínico Controlado
/
Estudio de prevalencia
/
Estudio pronóstico
/
Factores de riesgo
Límite:
Femenino
/
Humanos
/
Masculino
País/Región como asunto:
America del Norte
Idioma:
Inglés
Revista:
Rev. bras. cir. cardiovasc
Asunto de la revista:
Cardiología
/
Cirugía General
Año:
2016
Tipo del documento:
Artículo
País de afiliación:
Brasil
Institución/País de afiliación:
Instituto de Cardiologia-Fundação Universitária de Cardiologia/BR
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