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J Thorac Cardiovasc Surg 2004;128:432-435
© 2004 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Clopidogrel did not inhibit platelet function early after coronary bypass surgery: A prospective randomized trial

^a Departments of Cardiothoracic Surgery and Clinical Pharmacology, Papworth Hospital, Cambridge, UK
^b Medical Research Council Biostatistics Unit, Cambridge, United Kingdom

Presented at the Annual Meeting of the Society of Cardiothoracic Surgeons of Great Britain and Ireland, Guernsey, United Kingdom, March 7, 2004.

Received for publication January 25, 2004; revisions received February 19, 2004; accepted for publication March 4, 2004.

^* Address for reprints: Eric Lim, Department of Cardiothoracic Surgery, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, United Kingdom
eric.lim{at}cvsnet.org

OBJECTIVE: Although the beneficial effect of aspirin prescription after coronary surgery has been established, the efficacy of clopidogrel has never been compared with that of aspirin in the critical early postoperative period. We therefore conducted a prospective, double-blind, randomized controlled trial to compare the efficacies of these antiplatelet regimens.

METHODS: Patients undergoing elective primary coronary artery bypass surgery were invited to participate. After the operation, patients were randomized to receive 100 mg aspirin, 325 mg aspirin, or 75 mg clopidogrel tablets daily for 5 days. Our primary outcome measure was platelet aggregation on day 5, expressed as percentage of baseline. Assessment of platelet aggregation was undertaken with the technique of Born.

RESULTS: From September 2002 to July 2003, a total of 54 patients were randomized into the study. There were 2 self-withdrawals and 2 protocol violations, leaving 50 patients for analysis, 34 in the aspirin group and 16 in the clopidogrel arm. Compared with baseline, the mean percentage aggregations with collagen on day 5 were 56% for aspirin and 99% for clopidogrel. The mean difference between the two arms was 42% (95% confidence interval 27%-56%) in favor of aspirin. At the same time point, the effective concentration to inhibit 50% aggregation in the samples from patients randomly assigned to receive clopidogrel were not raised for our entire panel of agonists (changes of –0.04 µg/L for collagen, –0.01 µmol/L for epinephrine, and –0.02 µmol/L for adenosine diphosphate).

CONCLUSION: Clopidogrel, unlike aspirin, did not inhibit platelet aggregation in the first 5 postoperative days and therefore should not be used as a sole antiplatelet agent early after coronary surgery.

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