Early clopidogrel use in non–ST elevation acute coronary syndrome and subsequent coronary artery bypass grafting

Clopidogrel use is associated with a significant decrease in major adverse cardiac events when used in patients with non–ST elevation acute coronary syndromes (NSTE-ACS), and guidelines give a class I level of evidence A recommendation for the use of clopidogrel in these patients. The optimal timing...

Full description

Saved in:
Bibliographic Details
Published in:The American heart journal 2011-05, Vol.161 (5), p.832-841
Main Authors: Burke, Michael A., MD, Lee, Richard, MD, Fintel, Dan J., MD
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - physiopathology
Acute Coronary Syndrome - therapy
Acute coronary syndromes
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular
Coronary Artery Bypass - methods
Coronary heart disease
Coronary vessels
Drug therapy
Heart
Heart attacks
Humans
Medical sciences
Myocarditis. Cardiomyopathies
Platelet Aggregation Inhibitors - therapeutic use
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Clopidogrel use is associated with a significant decrease in major adverse cardiac events when used in patients with non–ST elevation acute coronary syndromes (NSTE-ACS), and guidelines give a class I level of evidence A recommendation for the use of clopidogrel in these patients. The optimal timing of clopidogrel use has not been conclusively determined, but nearly all data available support early use in patients with NSTE-ACS. Despite this, clopidogrel usage is far less than expected based on current guidelines because of concern for bleeding at the time of possible subsequent coronary artery bypass grafting (CABG). Clopidogrel use has been associated with increased perioperative bleeding at the time of CABG, but data are mixed. Numerous studies have conclusively shown that this bleeding risk is confined to those patients receiving clopidogrel within 5 days of CABG. The absolute number of patients exposed to this possible bleeding risk is very small relative to the >1 million patients who present annually with NSTE-ACS and is estimated to be
ISSN:0002-8703
1097-6744
DOI:10.1016/j.ahj.2011.01.020