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European Heart Journal 1985 6(2):168-175;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion

M. E. ROTHLIN*,, N. PFLUGER{dagger}, K. SPEISER{ddagger}, N. GOEBEL§, H.-P. KRAYENBÜHL, W. STEINBRUNN||, M. TURINA** and Å. SENNING**

*Department of Medicine, University Hospital CH—8091 Zürich
{dagger}Med. Klinik, Kantonsspital CH—6300 Zug
{ddagger}Med. Klinik, Kreisspital CH—8620 Wetzikon
§Röntgeninstitut, Universitätsspital CH—8091 Zürich
Med. Poliklinik, Universitätsspital CH—8091 Zürich
||Med. Klinik, Universitätsspital CH—8091 Zürich
**Chirurgische Klinik A, Universitätsspital CH—8091 Zürich

Received 16 November 1984; .

Address for reprints:Prof. M. E. Rothlin. Department of Medicine, University Hospital. CH — 8091 Zürich. Switzerland

Abstract

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization.

Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants forprevention of postoperative occlusion of aorto-coronary bypass grafts

Key Words: Ticlopidine • acenocoumarol • platelet inhibitors • anticoagulants • coronary bypass patency rate


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