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Ann Thorac Surg 2005;80:768-779
© 2005 The Society of Thoracic Surgeons
Cardiovascular Division and Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, Division of Cardiology, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
* Address reprint requests to Dr Cannon, TIMI Study Group, 350 Longwood Ave, First Floor, Boston, MA02115 (Email: cpcannon{at}partners.org).
Concern about possible hemorrhagic complications arising from use of oral antiplatelet agents in immediate proximity to coronary artery bypass graft (CABG) surgery leads many clinicians to avoid or discontinue these agents preoperatively. Recent evidence suggests that aspirin and clopidogrel can be used with relative safety in the preoperative period; dual antiplatelet therapy in the 5 days immediately preceding CABG surgery results in a moderate and variable increase in the risk of procedural bleeding. This modest hemorrhagic risk may be acceptable, given the clinical benefits of sustained antiplatelet therapy in preventing graft occlusion and ischemic complications pre- and post-CABG. Because the bleeding risk with aspirin is dose dependent, use of a low dose is preferred post-CABG.
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