Coronary artery bypass surgery postoperative antiplatelet therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2] Prince Tano Djan, BSc, MBChB [3]

2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease

Class I
“1. In patients treated with DAPT after coronary stent implantation who subsequently undergo CABG, P2Y12 inhibitor therapy should be resumed postoperatively so that DAPT continues until the recommended duration of therapy is completed.(Level of Evidence: C-EO)”
“2. In patients with ACS (NSTE-ACS or STEMI) being treated with DAPT who undergo CABG, P2Y12 inhibitor therapy should be resumed after CABG to complete 12 months of DAPT therapy after ACS(Level of Evidence: C-LD)”
“3. In patients treated with DAPT, a daily aspirin dose of 81 mg (range, 75 mg to 100 mg) is recommended(Level of Evidence: B-NR)”

Class IIb
“1. In patients with SIHD, DAPT (with clopidogrel initiated early postoperatively) for 12 months after CABG may be reasonable to improve vein graft patency (Level of Evidence: B-NR)”

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)[1]

2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery (DO NOT EDIT)^[1]

Class I
“1. If aspirin (100 mg to 325 mg daily) was not initiated preoperatively, it should be initiated within 6 hours postoperatively and then continued indefinitely to reduce the occurrence of saphenous vein graft closure and adverse cardiovascular events.^[2]^[3]^[4] (Level of Evidence: A)”

Class IIa
“1. For patients undergoing CABG, clopidogrel 75 mg daily is a reasonable alternative in patients who are intolerant of or allergic to aspirin. (Level of Evidence: C)”

References

↑ ^1.0 ^1.1 Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). “2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines”. Circulation. doi:10.1161/CIR.0b013e31823c074e. PMID 22064599.
↑ Mangano DT (2002). “Aspirin and mortality from coronary bypass surgery”. The New England Journal of Medicine. 347 (17): 1309–17. doi:10.1056/NEJMoa020798. PMID 12397188. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
↑ Sethi GK, Copeland JG, Goldman S, Moritz T, Zadina K, Henderson WG (1990). “Implications of preoperative administration of aspirin in patients undergoing coronary artery bypass grafting. Department of Veterans Affairs Cooperative Study on Antiplatelet Therapy”. Journal of the American College of Cardiology. 15 (1): 15–20. PMID 2404046. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
↑ “Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients”. BMJ (Clinical Research Ed.). 324 (7329): 71–86. 2002. PMC 64503. PMID 11786451. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)