To determine if specific antiplatelet therapy improved graft patency after coronary artery bypass grafting (CABG) -we compared (1) aspirin(325 mg qd), (2)aspirin(325 mg tid),(3) aspirin and dipyridamole(325 mg and 75 mg resp.tid), (4) sulfinpyrazone(267 mg tid) and (5) placebo(tid).Therapy was started 48 hours before CABGexcept for aspirin. When aspirin was a treatment,one 325 mg dose was given12 hours before surgery. Graft patency data were obtained early, one week, and then later, one year, after surgery. Preliminarydata, based on local interpretation of the angiograms at each center, in the firs 496 patients (1711 grafts), revealed thefollowing early graft patencies: aspiri qd (93%), aspirin tid (93%), aspirin and dipyridamole (93%),and sulfinpyrazone (92%). All these therapies improved(P<0.005)early graft patency compared to placebo (84%). Chest tube drainage measured within the first 35 hours after CABG revealed that the median loss with aspirintid (1114 ml) and aspirin and dipyridamole (972 ml) exceeded (P<0.001) placebo (802 ml) while aspirinqd (880 ml) and sulfinpyrazone (750 ml) did not. The reoperation rate was greater(P<0.01) in all the treatment groups thatcontained aspirin (6.1%) compared to the two non aspirin groups (1.9%). Overall operative mortality was 2.1%. In conclusion, graft patency was improved early after CABG with antiplatelet therapy. Two regimens which included preoperative aspirin has increased blood loss after CABG and preoperative aspirin increased the reoperation rate.
Significance and management of early graft failure after coronary artery bypass grafting Feasibility and results of acute angiography and re-re-vascularization
