Efficacy and safety of extended dual antiplatelet therapy beyond 12 months after coronary artery bypass grafting
10.3760/cma.j.cn112434-20230412-00083
- VernacularTitle:冠状动脉旁路移植术后延长双联抗血小板治疗超过12个月的有效性及安全性
- Author:
Mingzhen QIN
1
;
Yunpeng BAI
;
Xiankun LIU
;
Tongyun CHEN
;
Qingliang CHEN
;
Nan JIANG
;
Lianqun WANG
;
Qiang WANG
;
Zhigang GUO
Author Information
1. 天津医科大学研究生院，天津 300070
- Keywords:
Dual antiplatelet therapy;
Coronary artery bypass grafting;
Aspirin;
Clopidogrel;
Major cardiovascular and cerebrovascular adverse events
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2023;39(12):740-749
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of prolonged dual antiplatelet therapy (DAPT) (aspirin + clopidogrel) after coronary artery bypass grafting (CABG) for more than 12 months.Methods:1 900 patients who received CABG treatment in Tianjin Chest Hospital from January 2019 to October 2020 were continuously included, and 1 528 patients were finally identified according to the inclusion and exclusion criteria. According to whether the patients continued to take DAPT treatment 12 months after discharge, they were divided into the extended DAPT group and the standard DAPT group. Cox multivariate regression and propensity score matching (PSM) analysis were performed on major cardiovascular and cerebrovascular adverse events (MACCE) and clinically related bleeding events in the two groups during 12-24 months after discharge to evaluate the efficacy and safety of extended DAPT treatment for more than 12 months. Results:Of the 1 528 patients, 624 (40.8%) continued to take DAPT 12 months after discharge. Compared with patients receiving standard DAPT, patients receiving extended DAPT had a lower incidence of MACCE within 12 to 24 months ( HR=0.597, 95% CI: 0.399-0.892, P=0.012); ( HR=0.519, 95% CI: 0.338-0.798, P=0.003), and there was no significant increase in clinically relevant bleeding risk ( HR=1.209, 95% CI: 0.522-2.798, P=0.658), ( HR=1.112, 95% CI: 0.452-2.737, P=0.817). At the same time, prolonged DAPT treatment also brought a good net benefit. Conclusion:Prolonged DAPT treatment after CABG for more than 12 months significantly reduced the risk of ischemia at 12-24 months after surgery, and did not significantly increase the risk of bleeding at 12-24 months after surgery. It may be beneficial for patients treated with CABG to continue DAPT (aspirin+ clopidogrel) on the basis of intensive DAPT therapy for 1 year.
