دورية أكاديمية
أعرض في EDS

Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate.

التفاصيل البيبلوغرافية
العنوان: Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate.
المؤلفون: Prates PR; Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil., Williams JB; Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States., Mehta RH; Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States., Stevens SR; Duke Clinical Research Institute, Durham, NC, United States., Thomas L; Duke Clinical Research Institute, Durham, NC, United States., Smith PK; Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, United States., Newby LK; Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States., Kalil RA; Instituto de Cardiologia-Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil., Alexander JH; Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States., Lopes RD; Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, United States.
المصدر: Brazilian journal of cardiovascular surgery [Braz J Cardiovasc Surg] 2016 Apr; Vol. 31 (2), pp. 106-14.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Brazilian Society of Cardiovascular Surgery Country of Publication: Brazil NLM ID: 101677045 Publication Model: Print Cited Medium: Internet ISSN: 1678-9741 (Electronic) Linking ISSN: 01027638 NLM ISO Abbreviation: Braz J Cardiovasc Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: São Paulo, SP, Brasil : Brazilian Society of Cardiovascular Surgery, [2015]-
مواضيع طبية MeSH: Coronary Artery Bypass/*rehabilitation , Myocardial Revascularization/*rehabilitation , Platelet Aggregation Inhibitors/*therapeutic use , Postoperative Complications/*mortality , Ticlopidine/*analogs & derivatives, Aspirin/administration & dosage ; Aspirin/therapeutic use ; Cardiopulmonary Bypass/rehabilitation ; Clopidogrel ; Coronary Artery Bypass/methods ; Drug Therapy, Combination/mortality ; Female ; Humans ; Male ; Middle Aged ; Myocardial Revascularization/methods ; North Carolina ; Patient Discharge/statistics & numerical data ; Platelet Aggregation Inhibitors/administration & dosage ; Platelet Aggregation Inhibitors/standards ; Postoperative Care/mortality ; Postoperative Complications/drug therapy ; Postoperative Period ; Prevalence ; Prognosis ; Survival Rate ; Ticlopidine/administration & dosage ; Ticlopidine/standards ; Ticlopidine/therapeutic use
مستخلص: Introduction: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario.
Objective: Identify predictors of clopidogrel following CABG.
Methods: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG.
Results: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032).
Conclusion: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Competing Interests: None of the other authors have any conflict of interest to report related to this study.
References: BMJ. 1994 Jan 15;308(6922):159-68. (PMID: 8312766)
Lancet. 1996 Nov 16;348(9038):1329-39. (PMID: 8918275)
Am J Cardiol. 2009 Jun 15;103(12):1687-93. (PMID: 19539077)
Ann Thorac Surg. 2014 Jan;97(1):15-21. (PMID: 24206971)
Perfusion. 1998 Nov;13(6):389-407. (PMID: 9881387)
Thromb Haemost. 2007 Jul;98(1):201-9. (PMID: 17598014)
Circulation. 2004 Sep 7;110(10):1202-8. (PMID: 15313956)
J Am Coll Cardiol. 2010 Nov 9;56(20):1639-43. (PMID: 21050973)
Scand Cardiovasc J. 2003 Jun;37(3):149-53. (PMID: 12881156)
N Engl J Med. 2001 Aug 16;345(7):494-502. (PMID: 11519503)
Circulation. 2010 Dec 21;122(25):2680-7. (PMID: 21135365)
Ann Thorac Surg. 2007 Mar;83(3):993-1001. (PMID: 17307447)
J Am Coll Cardiol. 2009 Feb 10;53(6):530-53. (PMID: 19195618)
Lancet. 1984 Jun 9;1(8389):1261-4. (PMID: 6144975)
Rev Bras Cir Cardiovasc. 2011 Oct-Dec;26(4):525-31. (PMID: 22358266)
J Thromb Thrombolysis. 2013 Nov;36(4):384-93. (PMID: 23543398)
Circulation. 2001 Jan 23;103(3):363-8. (PMID: 11157686)
Arch Intern Med. 2006 Apr 10;166(7):806-11. (PMID: 16606819)
Circulation. 1994 Mar;89(3):1138-43. (PMID: 8124800)
Can J Cardiol. 2009 Dec;25(12):683-9. (PMID: 19960127)
Eur J Cardiothorac Surg. 2006 Feb;29(2):190-5. (PMID: 16388957)
Rev Bras Cir Cardiovasc. 2012 Jan-Mar;27(1):38-44. (PMID: 22729299)
Ann Thorac Surg. 2001 Sep;72(3):S1033-7. (PMID: 11565721)
Am J Cardiol. 1982 Feb 1;49(2):420-4. (PMID: 7058755)
Circulation. 1998 Mar 10;97(9):916-31. (PMID: 9521341)
Rev Bras Cir Cardiovasc. 2013 Oct-Dec;28(4):531-7. (PMID: 24598960)
Ann Thorac Surg. 1999 May;67(5):1370-5. (PMID: 10355414)
N Engl J Med. 1984 Jan 26;310(4):209-14. (PMID: 6361561)
Circulation. 1985 Jul;72(1):138-46. (PMID: 3874009)
Circulation. 1988 Jun;77(6):1324-32. (PMID: 3286040)
N Engl J Med. 1982 Jul 8;307(2):73-8. (PMID: 7045659)
معلومات مُعتمدة: U01 HL088953 United States HL NHLBI NIH HHS; UM1 HL088953 United States HL NHLBI NIH HHS
المشرفين على المادة: 0 (Platelet Aggregation Inhibitors)
A74586SNO7 (Clopidogrel)
OM90ZUW7M1 (Ticlopidine)
R16CO5Y76E (Aspirin)
تواريخ الأحداث: Date Created: 20160825 Date Completed: 20171127 Latest Revision: 20181202
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC5062735
DOI: 10.5935/1678-9741.20160019
PMID: 27556308
قاعدة البيانات: MEDLINE
الوصف
تدمد:1678-9741
DOI:10.5935/1678-9741.20160019