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The Journal of Thoracic and Cardiovascular Surgery, Vol 94, 773-783, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
R Limet, JL David, P Magotteaux, MP Larock and P Rigo
The efficacy of coronary bypass grafting obviously being linked to graft
patency, it is compulsory to look for any innovation that could improve the
patency rate. Ticlopidine, an antiplatelet drug, was tested against placebo
in a double-blind trial: 173 patients (475 grafts) subjected to venous
coronary artery bypass grafting were randomly treated with ticlopidine (250
mg twice daily) or placebo from the second postoperative day for 12 months.
Graft patency was assessed by digital angiography on days 10 (99.4% of the
patients), 180 (98.2%), and 360 (91.7%). The effect of treatment on
platelet aggregation and bleeding time were measured concomitantly; a
clear-cut effect was demonstrated at each interval. Intention-to-treat
graft-by-graft analysis shows that ticlopidine significantly reduced the
graft occlusion rate on day 10 (7.1% versus 13.4%, p less than 0.05), day
180 (15.0% versus 24.0%, p less than 0.02), and day 360 (15.9% versus
26.1%, p less than 0.01). Sequential grafts to the left anterior descending
coronary artery, with side-to-side anastomosis to diagonal branch(es), are
less frequently occluded than individual grafts. On the contrary, grafts to
endarterectomized vessels occlude more frequently. Individual
patient-by-patient analysis shows that patency of all grafts at each study
time, is more frequent in the ticlopidine group. The difference is
significant when one considers patients without sequential or
endarterectomized grafts. The difference is also present at each study
time: day 10 (84.4% versus 66.7%, p less than 0.05), day 180 (74.4% versus
52.3%, p less than 0.05) and day 360 (75.0% versus 52.5%, p less than
0.05). Results are even more impressive if one excludes from analysis the
four patients in the ticlopidine group in whom administration of the drug
was delayed. This supports previous suggestions that early therapy is
necessary. These results show that graft occlusion occurs mainly in the
first 6 postoperative months. The incidence of occlusion is significantly
reduced by ticlopidine therapy.
ARTICLES
Prevention of aorta-coronary bypass graft occlusion. Beneficial effect of ticlopidine on early and late patency rates of venous coronary bypass grafts: a double-blind study
Division of Surgery, University of Liege, Hopital de Baviere, Belgium.
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