Evidence for using clopidogrel alone or in addition to aspirin in post coronary artery bypass surgery patients
Patel JH et al. – Summarized data based on subgroup analyses, surrogate endpoints, and observational cohort studies fail to shhow a clear beneficial effect of clopidogrel alone or in combination with aspirin on clinical outcomes after coronary artery bypass grafting (CABG). Methods- Systematic review of published research to determine whether clopidogrel use after CABG is based on good trial data
- Review of studies reporting safety and/or efficacy data for clopidogrel use with/without aspirin after on-/off-pump CABG
Results- Inclusion criteria met by 14 studies: 11 reported trials; 3 ongoing trials
- Subgroup retrospective analyses of previously reported large trials of pts (1 pt) presenting with acute coronary syndromes or pts (3) with stable coronary artery disease did not show a clear clinical benefit of clopidogrel when given in addition to aspirin after CABG
- Trend toward increased major and minor bleeding after use of clopidogrel plus aspirin
- Quality inferior for meaningful conclusions: 2 small prospective trials providing data on surrogate endpoints and 5 small trials involving off-pump CABG pts
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