Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis

Roxana Sadeghi; Asrin Babahajian; Arash Sarveazad; Naser Kachoueian; Mansour Bahardoust

Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis

Arch Acad Emerg Med. 2020 May 31;8(1):e61. eCollection 2020.

Authors

Roxana Sadeghi^{1

2}, Asrin Babahajian³, Arash Sarveazad^{4

5}, Naser Kachoueian⁶, Mansour Bahardoust^{4

7}

Affiliations

¹ Department of cardiovascular Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Liver and Digestive Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.
⁴ Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
⁵ Nursing Care Research center, Iran University of Medical Sciences, Tehran, Iran.
⁶ Department of Cardiac Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁷ Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.

PMID: 32613203
PMCID: PMC7305656

Abstract

Introduction: Currently, the basis of acute coronary syndrome (ACS) therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor antagonists. Therefore, the aim of the present systematic review is to answer that should DAPT with Aspirin and clopidogrel be continued until coronary artery bypass grafting (CABG) in patients who have ACS?

Methods: The search for relevant studies in the present meta-analysis is based on three approaches: A) systematic searches in electronic databases, B) manual searches in Google and Google Scholar, and C) screening of bibliography of related original and review articles. The endpoints included mortality rate, myocardial infarction (MI), cerebrovascular accident (CVA), reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion after CABG.

Results: After the initial screening, 41 articles were studied in detail, and finally the data of 15 studies were included in the meta-analysis. DAPT before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events, but increases reoperation, re-exploration, length of ICU, and hospital stay. Chest tube drainage and blood product transfusion rate significantly increased in the DAPT group compared to the control group (non-antiplatelet or Aspirin alone). Increase in chest tube drainage and blood product transfusion rate indicates an increase in bleeding, so increase in reoperation, re-exploration to control bleeding, and, subsequently, increase in the length of ICU and hospital stay are expected.

Conclusions: DAPT with Aspirin and clopidogrel before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events despite more bleedings, and it may be suggested before CABG for better graft patency.

Keywords: Dual anti-platelet therapy; acute coronary syndrome; aspirin; clopidogrel; coronary artery bypass.

Publication types

Review