• Hani Shennib, Munemoto Endo, and Osama Benhameid.
• Division of Cardiothoracic Surgery, Montreal General Hospital, Montreal, Quebec, Canada. hani.shennib@muhc.mcgill.ca
• Heart Surg Forum. 2003 Jan 1; 6 (5): 288-91.

ObjectiveEffective antiplatelet therapy may decrease the risk of complications following off-pump coronary artery bypass surgery (CABG). We prospectively evaluated the safety and early efficacy of a combined regimen of clopidogrel and aspirin starting immediately after off-pump CABG.MethodsOne hundred thirty-five consecutive off-pump CABG patients received clopidogrel (75 mg/day) and aspirin (325 mg/day) orally or initially through a nasogastric tube for 3 months, commencing within 6 hours of surgery. Additionally, heparin (10,000 IU/day) was given subcutaneously during the first 4 postoperative days. Clinical events, including death, myocardial infarction (MI), reintervention, angiographically documented graft occlusion, stroke, pulmonary embolism (PE), deep vein thrombosis (DVT), and hemorrhagic events, were recorded. All patients were followed up for 3 months.ResultsThirteen of 135 off-pump CABG patients had treatment discontinued before discharge because of refractory atrial fibrillation requiring warfarin sodium (Coumadin) (6 patients), gastrointestinal bleeding (1 patient), DVT (1 patient), PE (1 patient), and death (4 patients). The remaining patients were followed up for 3 months. At 1 month, the incidences of the following events were: 3.0% cerebrovascular accidents (3 strokes and 1 transient ischemic attack), 3.0% MI, 0.7% DVT, and 0.7% hemothorax. At 3 months, no additional events had occurred except for 1 patient developing DVT and 2 additional patients developing MI. Coronary angiography was indicated in these last 2 patients. All grafts were found to be patent. However, a native vessel required percutaneous intervention (stenting) in one of these patients.ConclusionsEarly administration of a combined regimen of clopidogrel and aspirin following off-pump CABG is safe and is associated with a relatively low incidence of major adverse cardiac events, bleeding, PE, and DVT. Consequently, its routine administration after off-pump CABG is recommended.

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