Circulation, Vol 82, 765-773, Copyright © 1990 by American Heart Association
G Sanz, A Pajaron, E Alegria, I Coello, M Cardona, JA Fournier, M Gomez-Recio, J Ruano, R Hidalgo and A Medina
To analyze the efficacy of low-dose aspirin in preventing early
aortocoronary vein graft occlusion, 1,112 consecutive patients were
enrolled in a multicenter, randomized, double-blind, placebo-controlled
trial comparing 50 mg t.i.d. aspirin, 50 mg aspirin plus 75 mg t.i.d.
dipyridamole, and placebo. All patients received 100 mg q.i.d. dipyridamole
for 48 hours before surgery, and assigned treatment was started 7 hours
after surgery. Vein graft angiography was performed in 927 patients (83%)
within 28 days of surgery (mean, 10 days). Aspirin plus dipyridamole
significantly (p = 0.017) reduced the occlusion rate of distal anastomoses
from 18% (placebo) to 12.9%. Occlusion rate in the aspirin group was 14%,
which approached statistical significance (p = 0.058). Furthermore, only
aspirin plus dipyridamole reduced (p = 0.01) the number of patients with
occluded grafts (placebo, 33%; aspirin, 27.1%; aspirin plus dipyridamole,
24.3%). Mediastinal drainage was slightly higher (p = 0.04) in the aspirin
plus dipyridamole group (713 +/- 456 ml) than in the other two groups
(placebo, 670 +/- 437 ml; aspirin, 629 +/- 337 ml), but hospital mortality
(average, 4.6%) and early reoperation (average, 3.9%) rates were similar
among the three groups. Thus, low-dose aspirin plus dipyridamole safely
improves early saphenous vein aortocoronary graft patency; this effect is
an added benefit to a preoperative regimen of dipyridamole.
ARTICLES
Prevention of early aortocoronary bypass occlusion by low-dose aspirin and dipyridamole. Grupo Espanol para el Seguimiento del Injerto Coronario (GESIC)
Unidad Coronaria, Hospital Clinic, University of Barcelona, Spain.
This article has been cited by other articles:
 |
|
 |
|
  J. Dunning, M. Versteegh, A. Fabbri, A. Pavie, P. Kolh, U. Lockowandt, S. A.M. Nashef, and on behalf of the EACTS Audit and Guidelines Commit Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 73 - 92. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Zimmermann, E. Gams, and T. Hohlfeld Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 93 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. C. Becker, T. W. Meade, P. B. Berger, M. Ezekowitz, C. M. O'Connor, D. A. Vorchheimer, G. H. Guyatt, D. B. Mark, and R. A. Harrington The Primary and Secondary Prevention of Coronary Artery Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 776S - 814S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Epstein, J. C. Alexander, D. D. Gutterman, W. Maisel, and J. M. Wharton Anticoagulation: American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery Chest, August 1, 2005; 128(2_suppl): 24S - 27S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Stein, H. J. Schunemann, J. E. Dalen, and D. Gutterman Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 600S - 608S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Lim, Z. Ali, A. Ali, T. Routledge, L. Edmonds, D. G Altman, and S. Large Indirect comparison meta-analysis of aspirin therapy after coronary surgery BMJ, December 6, 2003; 327(7427): 1309. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Stein, J. E. Dalen, S. Goldman, and P. Theroux Antithrombotic Therapy in Patients With Saphenous Vein and Internal Mammary Artery Bypass Grafts Chest, January 1, 2001; 119 (2009): 278S - 282S. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L. Wilterdink and J. D. Easton Dipyridamole Plus Aspirin in Cerebrovascular Disease Arch Neurol, September 1, 1999; 56(9): 1087 - 1092. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. McCormick, J. H. Gurwitz, D. Lessard, J. Yarzebski, J. M. Gore, and R. J. Goldberg Use of Aspirin, {beta}-Blockers, and Lipid-Lowering Medications Before Recurrent Acute Myocardial Infarction: Missed Opportunities for Prevention? Arch Intern Med, March 22, 1999; 159(6): 561 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. W. Emery, N. L. Mills, F. J. Teijeira, K. V. Arom, P. Baldwin, R. J. Petersen, L. D. Joyce, G. L. B. Grinnan, M. S. Sussman, J. G. Copeland III, et al. North American Experience With the Perma-Flow Prosthetic Coronary Graft Ann. Thorac. Surg., September 1, 1996; 62(3): 691 - 695. [Abstract] [Full Text]
|
|
|
|
 |
|
 C. Patrono Aspirin as an Antiplatelet Drug N. Engl. J. Med., May 5, 1994; 330(18): 1287 - 1294. [Full Text]
|
|
|
|
 |
|
 J. H. Lemmer Jr., W. Stanford, S. L. Bonney, J. F. Breen, E. V. Chomka, W. J. Eldredge, W. W. Holt, R. B. Karp, G. W. Laub, M. J. Lipton, et al. Aprotinin for coronary bypass operations: Efficacy, safety, and influence on early saphenous vein graft patencyA multicenter, randomized, double-blind, placebo-controlled study J. Thorac. Cardiovasc. Surg., February 1, 1994; 107(2): 543 - 553. [Abstract] [Full Text]
|
|
|
|
|
|
Collaborative overview of randomised trials of antiplatelet therapy - II: Maintenance of vascular graft or arterial patency by antiplatelet therapy BMJ, January 15, 1994; 308(6922): 159 - 168. [Abstract] [Full Text]
|
|
|
|
|
|
Antiplatelet Trialists Collaborative overview of randomised trials of antiplatelet therapy Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients BMJ, January 8, 1994; 308(6921): 81 - 106. [Abstract] [Full Text]
|
|