Heart surgeons don't have to choose between taking a coronary-bypass patient off the popular anti-clotting drug clopidogrel (Plavix) after off-pump heart bypass surgery or having the patient bleed excessively in the days following surgery, according to a new study by researchers at Jefferson Medical College.
The study, to be presented at the American College of Cardiology's 56th Annual Scientific Session, (abstract 1027-18), found that Plavix, when used in addition to aspirin, will not worsen bleeding after off-pump heart bypass surgery.
The researchers led by David Whellan, M.D., assistant professor of Medicine at Jefferson Medical College of Thomas Jefferson University, conducted a retrospective study of more than 7, 000 patients who underwent off-pump heart bypass surgery. They report that the anti-platelet drug program appears safe--post surgery--when used with aspirin. Overall, they found that patients who took clopidogrel and aspirin experienced less gastrointestinal bleeding and fewer strokes and other cardiovascular complications than patients who were on aspirin alone.
"The new off-pump strategy is a proven surgical advance in the treatment of heart disease," Dr. Whellan says. "Improving outcomes for patients undergoing bypass surgery and keeping the new bypass grafts open is a critical issue. One possible strategy is to use clopidogrel, but there have been safety concerns, particularly regarding the risk of bleeding after surgery."
The researchers used data provided by the University HealthSystem Consortium (UHC), an alliance of 97 academic medical centers and 149 of their affiliated hospitals representing nearly 90 percent of the nation's non-profit academic medical centers. The data were culled from over 800 institutions including more than 70 academic medical centers.
Data were used from patients who underwent off-pump coronary artery bypass surgery, known as OPCABG, and were treated with aspirin alone or with aspirin and clopidogrel. Data on patients who received anticoagulation agents for valve replacement and/or atrial fibrillation was excluded. Some 3,512 patients took only aspirin; 3,814 patients were treated with the aspirin and clopidogrel.
"We have learned from our cardiologist colleagues that routine clopidogrel use after angioloplasty and stenting has added a long-term benefit of increased stent effectiveness," adds Scott Silvestry, M.D., assistant professor of Surgery at Jefferson Medical College of Thomas Jefferson University. "This study has shown that we can extend this potential benefit to our off-pump bypass grafts in a safe fashion by utilizing clopidogrel postoperatively without adverse bleeding events."
"The next step will be to evaluate the addition of clopidogrel in a prospective study," Dr. Whellan says.
Materials provided by Thomas Jefferson University. Note: Content may be edited for style and length.
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