The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 807-810.e7 , October 2009

Antiplatelet agents used for early intervention in acute coronary syndrome: Myocardial salvage versus bleeding complications

  • Sary F. Aranki, MD

      Affiliations

    • Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass
    • Corresponding Author InformationAddress for reprints: Sary Aranki, MD, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
  • ,
  • Simon C. Body, MBChB, MPH

      Affiliations

    • Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass

Received 6 January 2009 ,Revised 26 March 2009 ,Accepted 11 April 2009.

References 

  1. Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics—2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117:e25–146
  2. Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116:e148–e304
  3. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2008;51:210–247
  4. Lagerqvist B, Husted S, Kontny F, Stahle E, Swahn E, Wallentin L. 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006;368:998–1004
  5. Neumann FJ, Kastrati A, Pogatsa-Murray G, Mehilli J, Bollwein H, Bestehorn HP, et al. Evaluation of prolonged antithrombotic pretreatment (“cooling-off” strategy) before intervention in patients with unstable coronary syndromes: a randomized controlled trial. JAMA. 2003;290:1593–1599
  6. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–2216
  7. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324:71–86
  8. Bowry AD, Brookhart MA, Choudhry NK. Meta-analysis of the efficacy and safety of clopidogrel plus aspirin as compared to antiplatelet monotherapy for the prevention of vascular events. Am J Cardiol. 2008;101:960–966
  9. Eikelboom JW, Hirsh J. Bleeding and management of bleeding. Eur Heart J Suppl. 2006;8:G38–G45
  10. Steinhubl SR, Kastrati A, Berger PB. Variation in the definitions of bleeding in clinical trials of patients with acute coronary syndromes and undergoing percutaneous coronary interventions and its impact on the apparent safety of antithrombotic drugs. Am Heart J. 2007;154:3–11
  11. Cannon CP, Mehta SR, Aranki SF. Balancing the benefit and risk of oral antiplatelet agents in coronary artery bypass surgery. Ann Thorac Surg. 2005;80:768–779
  12. Fox KA, Mehta SR, Peters R, Zhao F, Lakkis N, Gersh BJ, et al. Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non–ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial. Circulation. 2004;110:1202–1208
  13. McLean DS, Sabatine MS, Guo W, McCabe CH, Cannon CP. Benefits and risks of clopidogrel pretreatment before coronary artery bypass grafting in patients with ST-elevation myocardial infarction treated with fibrinolytics in CLARITY–TIMI 28. J Thromb Thrombol. 2007;24:85–91
  14. CRUSADE Quarter 4, 2006 Results. 2007 [cited 2007 December 3, 2007]; Available from: http://crusadeqi.com/Main/Ecab/Slides/CRUSADEResults2006Q4.ppt#343,16, Slide16.
  15. Fox KA, Anderson FA, Dabbous OH, Steg PG, Lopez-Sendon J, Van de Werf F, et al. Intervention in acute coronary syndromes: do patients undergo intervention on the basis of their risk characteristics? The Global Registry of Acute Coronary Events (GRACE). Heart. 2007;93:177–182
  16. Yang EH, Gumina RJ, Lennon RJ, Holmes DR, Rihal CS, Singh M. Emergency coronary artery bypass surgery for percutaneous coronary interventions: changes in the incidence, clinical characteristics, and indications from 1979 to 2003. J Am Coll Cardiol. 2005;46:2004–2009
  17. Mack MJ. Beating heart surgery: does it make a difference?. Am Heart Hosp J. 2003;1:149–157
  18. Snyder-Ramos SA, Mohnle P, Weng YS, Bottiger BW, Kulier A, Levin J, et al. The ongoing variability in blood transfusion practices in cardiac surgery. Transfusion. 2008;48:1284–1299
  19. Mehta RH, Roe MT, Mulgund J, Ohman EM, Cannon CP, Gibler WB, et al. Acute clopidogrel use and outcomes in patients with non-ST-segment elevation acute coronary syndromes undergoing coronary artery bypass surgery. J Am Coll Cardiol. 2006;48:281–286
  20. Bracey AW, Radovancevic R. The hematologic effects of cardiopulmonary bypass and the use of hemotherapy in coronary artery bypass grafting. Arch Pathol Lab Med. 1994;118:411–416
  21. Pickard AS, Becker RC, Schumock GT, Frye CB. Clopidogrel-associated bleeding and related complications in patients undergoing coronary artery bypass grafting. Pharmacotherapy. 2008;28:376–392
  22. Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI–CURE study. Lancet. 2001;358:527–533
  23. Violette PD, Filion KB, Haider S, Pilote L, Eisenberg MJ. A cost analysis of nonelective coronary artery bypass graft surgery. J Card Surg. 2006;21:621–627
  24. Kuchulakanti P, Kapetanakis EI, Lew R, Rha SW, Cheneau E, Satler LF, et al. Impact of continued hospitalization in patients pre-treated with clopidogrel prior to coronary angiography and undergoing coronary artery bypass grafting. J Invasive Cardiol. 2005;17:5–7

 This commentary was written and edited by the authors, who take full responsibility for its content. Editorial assistance with searching the literature, coordinating revisions, and creating the figure and tables in preparation of this manuscript was provided by Melanie Leiby, PhD, and funded by the Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership. Drs Aranki and Brody did not receive any compensation for this work.

PII: S0022-5223(09)00870-8

doi: 10.1016/j.jtcvs.2009.04.052

The Journal of Thoracic and Cardiovascular Surgery
Volume 138, Issue 4 , Pages 807-810.e7 , October 2009