| Authors |
| Kulik A, Le May MR, Voisine P,et al. |
| Title |
| Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting: The Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) Trial. |
| References |
| Circulation 2010;122:2680-2687. |
| Background |
| Coronary artery bypass grafting (CABG) involving the saphenous vein graft (SVG) is associated with reduced graft patency. Aspirin improves SVG patency, however it does not inhibit intimal hyperplasia. Clopidogrel inhibits intimal proliferation and smooth muscle hyperplasia. |
| Purpose |
| To determine whether the addition of clopidogrel to aspirin inhibits SVG disease. |
| Design |
- Randomized, double-blind phase ll trial
- 113 patients scheduled for first-time CABG with at least 2 SVG’s, with or without the use of cardiopulmonary bypass.
- IVUS was used to assess the area of SVG intimal hyperplasia 1 year after surgery. Angiography was done before IVUS to check the patency of all bypass grafts.
|
| Exclusion Criteria |
| None. |
| Follow-Up |
| 1 year |
| Treatment Regimen |
| Postoperatively: Clopidogrel 75 mg/day vs matching placebo. All patients received aspirin 162 mg/day (Treatment for 1 year) |
| Results |
Primary Endpoint: mean SVG intimal area per patient at 1 year. There was no significant difference in the primary endpoint in the aspirin vs aspirin-clopidogrel group (4.1 ± 2.0 mm2 vs 4.5 ± 2.1 mm2, p=0.44). SVG patency was 93.2% (aspirin) vs 94.3% (aspirin-clopidogrel; p=0.69). The risk of major bleeding was not significantly different between aspirin and aspirin-clopidogrel (0% vs 1.8%, p=0.50) |
| Summary |
| There is no benefit in adding clopidogrel to aspirin to reduce SVG intimal hyperplasia 1 year after coronary bypass grafting. |
| Implications |
| None. |
| Related Figures |
| [6, 18] |