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Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate.

dc.contributor.author Prates, Paulo Roberto L
dc.contributor.author Williams, Judson B
dc.contributor.author Mehta, Rajendra H
dc.contributor.author Stevens, Susanna R
dc.contributor.author Thomas, Laine
dc.contributor.author Smith, Peter K
dc.contributor.author Newby, L Kristin
dc.contributor.author Kalil, Renato AK
dc.contributor.author Alexander, John H
dc.contributor.author Lopes, Renato D
dc.coverage.spatial Brazil
dc.date.accessioned 2017-02-07T14:49:41Z
dc.date.available 2017-02-07T14:49:41Z
dc.date.issued 2016-04
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/27556308
dc.identifier S0102-76382016000200106
dc.identifier.uri https://hdl.handle.net/10161/13607
dc.description.abstract INTRODUCTION: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. OBJECTIVE: Identify predictors of clopidogrel following CABG. METHODS: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. RESULTS: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). CONCLUSION: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
dc.language eng
dc.publisher Sociedade Brasileira de Cirurgia Cardiovascular
dc.relation.ispartof Braz J Cardiovasc Surg
dc.relation.isversionof 10.5935/1678-9741.20160019
dc.title Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate.
dc.type Journal article
duke.contributor.id Williams, Judson B|0222974
duke.contributor.id Mehta, Rajendra H|0304061
duke.contributor.id Thomas, Laine|0402620
duke.contributor.id Smith, Peter K|0052720
duke.contributor.id Newby, L Kristin|0113385
duke.contributor.id Alexander, John H|0098973
duke.contributor.id Lopes, Renato D|0417085
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/27556308
pubs.begin-page 106
pubs.end-page 114
pubs.issue 2
pubs.organisational-group Basic Science Departments
pubs.organisational-group Biostatistics & Bioinformatics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Cardiology
pubs.organisational-group School of Medicine
pubs.organisational-group Surgery
pubs.organisational-group Surgery, Cardiovascular and Thoracic Surgery
pubs.publication-status Published
pubs.volume 31
dc.identifier.eissn 1678-9741
duke.contributor.orcid Newby, L Kristin|0000-0002-6394-8187
duke.contributor.orcid Alexander, John H|0000-0002-1444-2462
duke.contributor.orcid Lopes, Renato D|0000-0003-2999-4961


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