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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mariano E. Brizzio Alex Zapolanski Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brizzio, M. E. Articles by Zapolanski, A. Search for Related Content PubMed Articles by Brizzio, M. E. Articles by Zapolanski, A. Related Collections Coronary disease Related Article

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Correspondence

Reply

The Valley-Columbia Heart Center, 223 N Van Dien, Ridgewood, NJ 07645

(Email: brizma{at}valleyhealth.com).

To the Editor:

We thank Dr Savage [1] for his comments about our study [2]. The letter raises the question about the perioperative management of antiplatelet therapy of the population studied. Considering the total cohort of 4869 patients, 96.2% started receiving aspirin within 24 hours after the operation, and only 24 patients (0.49%) received clopidogrel as well. After including this variable in the propensity match analysis, we found no statistical significant difference between the two groups: 10 patients received clopidogrel in the on-pump group and 14 in the off- pump group (p = 0.2).

Dr Savage [1] makes a very important point in considering the clopidogrel as a possible confounding bias. In this cohort, however, even though the number of patients treated with clopidogrel was very small, it definitely did not alter the stroke rate and its complications.

Nevertheless, an estimated 20% to 30% of cardiac surgeons use clopidogrel and aspirin together in treating postoperative coronary artery bypass grafting patients by assuming empirically "clopidogrel could be more protective" [3]. To date, however, there is no supportive evidence that the dual antiplatelet therapy clearly benefits these patients in graft patency or, more specifically, in postoperative stroke, as was recently shown in the Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) trial results [3].

	References

Top References

 

1. Savage EB. Did clopidogrel confound the results?(letter) Ann Thorac Surg 2011;91:989.[Free Full Text]
2. Brizzio ME, Zapolanski A, Shaw RE, Sperling JS, Mindich BP. Stroke-related mortality in coronary surgery is reduced by the off-pump approach Ann Thorac Surg 2010;89:19-23.[Abstract/Free Full Text]
3. CASCADE trial: aspirin alone as effective as aspirin and clopidogrel in preventing vein graft disease post CABGPresented at: American Heart Association Annual Meeting Scientific Sessions, Nov 2009http://www.theheart.org/article/1024575.do 2010.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mariano E. Brizzio Alex Zapolanski Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brizzio, M. E. Articles by Zapolanski, A. Search for Related Content PubMed Articles by Brizzio, M. E. Articles by Zapolanski, A. Related Collections Coronary disease Related Article