Copyright © 1992 by the European Society of Cardiology.
© 1992 The European Society of Cardiology
Efficacy and safety of anticoagulant therapy started pre-operatively in preventing coronary vein graft occlusion
YRY
HEIMODivision of Cardiology, Department of Medicine, Oulu University Central Hospital Oulu, Finland
Received 15 August 1991; revised 6 April 1992; .
Correspondence: Sinikka Yh-Mãyry, MD, Division of Cardiology, Department of Medicine, Oulu University Central Hospital, 90220 Oulu, Finland
Abstract
Oral anticoagulant therapy with warfarin commenced pre-operatively (n = 102) to prevent coronary artery vein graft occlusions was compared in terms of efficacy and safety with dipyridamole and aspirin (n = 130) in a randomized consecutive series of patients. Anticoagulant therapy was started at least 2 weeks before coronary artery bypass surgery (CA BG) and antiplatelet therapy was started at least 3 days before CA BG with dipyridamole followed by a combination of 250 mg aspirin once a day via a nasogastric tube 6 h after CABG. Overall, vein graft patency at 3 months after surgery did not differ significantly between the anticoagulant group (203/275, 74%) and dipyridamole-aspirin group (238/311, 77%), but the occlusion rate for grafts with endarterectomy was higher in the anticoagulant (46%) than in the dipyridamole and aspirin group (16%), (P<0·05). The rate of peri-operative complications including deaths, re-operation and myocardial infarction was higher in the anticoagulant than antiplatelet group (26·5% vs 13·8%, P < 0·05). The occurrence of postoperative bleeding complications did not differ significantly between the groups. Thus, oral anticoagulant therapy commenced pre-operatively has no advantages over conventional antiplatelet therapy in patients who undergo CABG. Neither antithrombotic regimens proved to be satisfactory for preventing acute bypass vein graft occlusions in this patient population with advanced coronary artery disease.
Key Words: Anticoagulation • antiplatelet • bypass grafting
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