Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate.
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2016-04
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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.
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Prates, Paulo Roberto L, Judson B Williams, Rajendra H Mehta, Susanna R Stevens, Laine Thomas, Peter K Smith, L Kristin Newby, Renato AK Kalil, et al. (2016). Clopidogrel use After Myocardial Revascularization: Prevalence, Predictors, and One-Year Survival Rate. Braz J Cardiovasc Surg, 31(2). pp. 106–114. 10.5935/1678-9741.20160019 Retrieved from https://hdl.handle.net/10161/13607.
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Judson Blount Williams
"A North Carolina native, Dr. Williams believes in the mission of providing the best cardiovascular care that can be found in the world in his home state through WakeMed Health and Hospitals, Duke Health, and the HeartCare Plus collaborative. He feels fortunate to be part of the Heart Center because of the unique way he and his colleagues including anesthesiologists, physician assistants, surgical and heart center nurses, intensivists, and many others commit to individual patient care. Patients may expect from Dr. Williams a clear plan of care, compassion, and a patient-centered approach throughout their surgical consultation, procedures, and recovery."
Laine Elliott Thomas
Laine Thomas, PhD, joined the Department of Biostatistics and Bioinformatics and DCRI in 2009. She serves as Associate Chair for Equity, Diversity and Inclusion within the Department of Biostatistics and Bioinformatics and Deputy Director of Data Science and Biostatistics at the Duke Clinical Research Institute. She is a leader in study design and development of methods for observational and pragmatic studies, with over 240 peer reviewed clinical and methodological publications arising from scientific collaboration in the therapeutic areas of cardiovascular disease, diabetes, uterine fibroids and SARS-CoV-2 virus. She led the statistical teams on the HERO COVID-19, ORBIT-AF I & II, ACTION-CMS, CHAMP-HF, and COMPARE-UF clinical registries and secondary analyses of the NAVIGATOR and ARISTOTLE clinical trials. She has served as a primary investigator and co-investigator on numerous methodological studies with funding from NIH, AHRQ, PCORI and Burroughs Wellcome Fund, addressing observational treatment comparisons, time-varying treatments, heterogeneity of treatment effects, and randomized trials augmented by synthetic controls from real world data.
Laura Kristin Newby
Research Description
General Focus: Clinical investigation the process and treatment of acute and chronic coronary artery disease and systems issues for delivery of care to patients with these illnesses. Particular interests include management of patients with chest pain and unstable angina, evaluation of the use of biochemical markers other than CK-MB for diagnosis and risk stratification in these patients, issues related to coronary artery disease in women, and systems issues regarding optimizing the process of delivery of care to patients with acute and chronic coronary artery disease. Finally, I have a strong interest in defining the genetic contribution to development of coronary artery disease.
Key words: coronary artery disease acute myocardial infarction unstable angina chest pain women biochemical markers risk stratification genetics
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