Author/Authors :
Sadeghi, Roxana Department of cardiovascular Medicine - School of Medicine - Shahid Beheshti University of Medical Sciences, Tehran , Babahajian, Asrin Liver and Digestive Research Center - Kurdistan University of Medical Sciences, Sanandaj , Sarveazad, Arash Colorectal Research Center - Iran University of Medical Sciences, Tehran , Kachoueian, Naser Department of Cardiac Surgery - School of Medicine - Shahid Beheshti University of Medical Sciences, Tehran , Bahardoust, Mansour Colorectal Research Center - Iran University of Medical Sciences, Tehran
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. Conclusion: 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 , coronary artery bypass , acute coronary syndrome , aspirin , clopidogrel
