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J Thorac Cardiovasc Surg 1994;107:1146-1153
© 1994 Mosby, Inc.

SURGERY FOR ACQUIRED HEART DISEASE

Effects of antiplatelet therapy with indobufen or aspirin-dipyridamole on graft patency one year after coronary artery bypass grafting

S. M. Rajah, MBBS, MRCP (UK), FRCPEa, U. Nair, MS, FRCSa, M. Rees, BSc, MB ChB, MRCP, DMRD, SRCRa, N. Saunders, MA, MB, FRCSa, D. Walker, MB ChB, FRCSa, G. Williams, MB, FRCP, FACCa, A. Critchley, MBBSa, D. Beton, BSc, MB ChB, DMRDb, C. Campbell, BSc, FRCS (CTH)b, R. A. Lawson, FRCSb, A. Rahman, MBBS, FRCSb, K. K. Nair, FRCS (Eng), FACSc, J. Dyet, MB ChB, FRCR, DMRDd, S. Kushwaha, MBBS, MRCP, MDe, A. Rees, FRCSe, J. D. Powell, MScf, J. Drake, f


Leeds, Manchester, North Humberside, Hull, Harefield,and St.Albans, United Kingdom

Supported by Farmitalia Carlo Erba.

Received for publication May 11, 1993. Accepted for publication Sept. 27, 1993. Address for reprints: S. M. Rajah, MBBS, MRCP (UK), FRCPE, Killingbeck Hospital, York Rd., Leeds, United Kingdom.

Abstract

Saphenous vein coronary artery bypass graft patency can be increased by antiplatelet therapy. Aspirin plus dipyridamole are effective but are associated with tolerability problems. Indobufen is a possible alternative antiplatelet agent that may be better tolerated. A prospective, randomized, double-blind, parallel-group study was undertaken to compare the efficacy and safety of indobufen 200 mg twice daily with aspirin 300 mg thrice daily plus dipyridamole 75 mg thrice daily in preventing occlusion of autologous saphenous vein coronary artery bypass grafts. A total of 803 patients were randomized in the study, of whom 552 had a follow-up coronary angiogram approximately 1 year after operation. All anastomoses were patent in 56% of indobufen-treated patients and 59% of aspirin-dipyridamole recipients (p = 0.384). The percentage of all anastomoses patent was 82% in the indobufen group and 83% in the aspirin-dipyridamole group (p = 0.297). Mean postoperative blood loss was significantly less in the indobufen group (p = 0.043). Patients who received indobufen also had significantly fewer adverse events considered to be treatment-related compared with aspirin-dipyridamole recipients (p = 0.02). At the doses tested indobufen was as effective as aspirin plus dipyridamole in preventing occlusion of saphenous vein grafts and was better tolerated. Because indobufen was associated with less postoperative blood loss it may be used before operation in coronary artery bypass grafting. (J THORAC CARDIOVASC SURG1994;107:1146-53)




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