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Evidence for using clopidogrel alone or in addition to aspirin in post coronary artery bypass surgery patients
The American Journal of Cardiology, 06/22/09

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