Impact of Dual Antiplatelet Therapy on Outcomes Among Aspirin-Resistant Patients Following Coronary Artery Bypass Grafting

• Published in: The American journal of cardiology 2014-05, Vol.113 (10), p.1660-1667
• Main Authors: Gasparovic, Hrvoje, MD, PhD, Petricevic, Mate, MD, Kopjar, Tomislav, MD, Djuric, Zeljko, MD, Svetina, Lucija, MD, Biocina, Bojan, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Aged; Aspirin; Aspirin - administration & dosage; Blood platelets; Cardiovascular; Cardiovascular disease; Coronary Artery Bypass; Coronary Artery Disease - therapy; Coronary vessels; Croatia - epidemiology; Dose-Response Relationship, Drug; Drug Resistance; Drug therapy; Drug Therapy, Combination; Electrodes; Enzymes; Female; Follow-Up Studies; Heart attacks; Heart surgery; Hospitalization; Hospitals; Humans; Hypotheses; Incidence; Male; Mortality; Platelet Aggregation Inhibitors - administration & dosage; Postoperative Care - methods; Postoperative Complications - epidemiology; Retrospective Studies; Stroke; Studies; Survival Rate - trends; Ticlopidine - administration & dosage; Ticlopidine - analogs & derivatives; Treatment Outcome; Values
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2014.02.024

Coronary artery bypass grafting is pivotal in the contemporary management of complex coronary artery disease. Interpatient variability to antiplatelet agents, however, harbors the potential to compromise the revascularization benefit by increasing the incidence of adverse events. This study was designed to define the impact of dual antiplatelet therapy (dAPT) on clinical outcomes among aspirin-resistant patients who underwent coronary artery surgery. We randomly assigned 219 aspirin-resistant patients according to multiple electrode aggregometry to receive clopidogrel (75 mg) plus aspirin (300 mg) or aspirin-monotherapy (300 mg). The primary end point was a composite outcome of all-cause death, nonfatal myocardial infarction, stroke, or cardiovascular hospitalization assessed at 6 months postoperatively. The primary end point occurred in 6% of patients assigned to dAPT and 10% of patients randomized to aspirin-monotherapy (relative risk 0.61, 95% confidence interval 0.25 to 1.51, p = 0.33). No significant treatment effect was noted in the occurrence of the safety end point. The total incidence of bleeding events was 25% and 19% in the dAPT and aspirin-monotherapy groups, respectively (relative risk 1.34, 95% confidence interval 0.80 to 2.23, p = 0.33). In the subgroup analysis, dAPT led to lower rates of adverse events in patients with a body mass index >30 kg/m2 (0% vs 18%, p