Our Summary

This research paper is about the use of a type of medication called antiplatelet therapy during and after a type of heart surgery called coronary artery bypass grafting (CABG). The researchers noticed that the use of these medicines varies greatly, probably because there are not many studies focused on these patients and the studies that are available report different results.

The study highlights how often graft closure (the closing of a bypass graft in the heart) happens, how it happens, and the evidence that supports the use of antiplatelet therapy. This is balanced against the risk of bleeding caused by the therapy.

The researchers found that a low dose of a drug called acetylsalicylic acid (ASA) reduces the risk of heart attacks, kidney injuries, and death during and after surgery, without increasing the risk of bleeding. So they recommend using this drug before and after CABG.

They also found that using ASA along with another drug that prevents platelets from clumping together (a P2Y12 antagonist) increases the risk of bleeding.

Based on their study, they suggest that if a patient is taking clopidogrel before surgery, the surgery should be delayed for five days because of an increased risk of bleeding and death. If a patient is taking ticagrelor, the surgery should be delayed for three days, and if they’re taking prasugrel, it should be delayed for seven days.

For patients who had a heart stent placed before surgery or had a heart attack before surgery, restarting their P2Y12 antagonist after surgery for 12 months reduces the risk of future cardiovascular events.

FAQs

  1. What is the recommended use of antiplatelet therapy in patients undergoing coronary artery bypass grafting (CABG)?
  2. How does the use of dual antiplatelet therapy impact patients undergoing CABG?
  3. What are the recommendations for the delay of CABG surgery for patients treated with clopidogrel, ticagrelor, and prasugrel preoperatively?

Doctor’s Tip

A helpful tip a doctor might tell a patient about CABG is to continue taking low-dose acetylsalicylic acid (ASA) both before and after the procedure to reduce the risk of perioperative complications such as myocardial infarction and mortality. It is important to balance the benefits of antiplatelet therapy with the potential risk of bleeding, and to follow the recommended guidelines for the use of dual antiplatelet therapy if necessary. If the patient is on a P2Y12 antagonist such as clopidogrel, ticagrelor, or prasugrel, the doctor may advise on the optimal timing for CABG to minimize the risk of bleeding complications. Additionally, for patients who had a coronary stent placed or had an acute coronary syndrome preoperatively, resuming their P2Y12 antagonist postoperatively may help reduce the risk of cardiovascular events.

Suitable For

Patients who are typically recommended coronary artery bypass grafting (CABG) include those with severe coronary artery disease, especially those with significant blockages in multiple coronary arteries, those with left main coronary artery disease, and those who have not responded well to other treatments such as medication or angioplasty. Patients who have had a heart attack or angina that is not well controlled with medication may also be recommended for CABG. Additionally, patients with complex coronary anatomy or those who are at high risk for complications from other treatments may also be candidates for CABG.

Timeline

Before CABG:

  • Patient undergoes diagnostic tests such as angiography to determine extent of coronary artery disease
  • Patient may undergo medical management with medications to control symptoms and reduce risk of complications
  • Patient may receive counseling on lifestyle changes to improve heart health
  • Patient may undergo preoperative evaluations and preparations for surgery

After CABG:

  • Patient is closely monitored in the intensive care unit immediately following surgery
  • Patient may require mechanical ventilation and monitoring of vital signs
  • Patient is gradually weaned off of mechanical support and pain medications
  • Patient begins physical therapy and rehabilitation to regain strength and mobility
  • Patient is discharged from the hospital and receives instructions for at-home care and follow-up appointments
  • Patient may be prescribed medications such as antiplatelet therapy to prevent complications and improve long-term outcomes

Overall, the goal of CABG is to improve blood flow to the heart muscle, reduce symptoms of coronary artery disease, and improve overall quality of life for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about CABG and antiplatelet therapy include:

  1. What is the recommended antiplatelet therapy before and after my CABG surgery?
  2. How long do I need to take antiplatelet medications after my surgery?
  3. What are the potential risks and benefits of antiplatelet therapy for me personally?
  4. If I am already taking antiplatelet medications for another condition, how will this be managed during and after my CABG surgery?
  5. Are there any specific precautions or considerations I should be aware of regarding antiplatelet therapy and my CABG surgery?
  6. Will I need to have any additional monitoring or follow-up visits related to my antiplatelet therapy after my surgery?
  7. Are there any alternative medications or treatment options I should consider instead of or in addition to antiplatelet therapy for my condition?

Reference

Authors: DeStephan CM, Schneider DJ. Journal: Kardiol Pol. 2018;76(6):945-952. doi: 10.5603/KP.a2018.0111. Epub 2018 May 21. PMID: 29781070