Abstract
Treatment with the combination of aspirin and dipyridamole is believed to reduce the incidence of coronary vein graft occlusion. A double blind randomised controlled trial was carried out in which aspirin 990 mg and dipyridamole 225 mg daily or placebo were added to the routine postoperative management (warfarin for three months) of 320 patients undergoing coronary bypass grafting. The trial treatment was given for 12 months, after which the results were assessed by coronary and graft angiography. The two randomised groups, each of 160 patients, were comparable in age, sex, symptomatic state, angiographic findings, and operative procedure. Repeat coronary arteriography was carried out on 266 patients, 133 in each group. All grafts and distal anastomoses were patent in 68% (91/133) of the placebo patients and in 75% (100/133) of those receiving active treatment. Overall graft patency was 87% (306/352) and 89% (342/385) respectively. Retrospective subgroup analysis showed patency rates of 72% (26/36) and 78% (39/50) of grafts to vessels requiring preliminary endarterectomy, and 80% (36/45) and 91% (40/44) of distal anastomoses to vessels measured at operation to have a diameter of less than or equal to 1 mm. None of these differences was significant at the 5% level. Thus in this group of patients with high graft patency rates, treatment with aspirin and dipyridamole conferred no appreciable advantage.
Full text
PDF






Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baur H. R., VanTassel R. A., Pierach C. A., Gobel F. L. Effects of sulfinpyrazone on early graft closure after myocardial revascularization. Am J Cardiol. 1982 Feb 1;49(2):420–424. doi: 10.1016/0002-9149(82)90519-7. [DOI] [PubMed] [Google Scholar]
- Bonchek L. I., Boerboom L. E., Olinger G. N., Pepper J. R., Munns J., Hutchinson L., Kissebah A. H. Prevention of lipid accumulation in experimental vein bypass grafts by antiplatelet therapy. Circulation. 1982 Aug;66(2):338–341. doi: 10.1161/01.cir.66.2.338. [DOI] [PubMed] [Google Scholar]
- Brooks N., Honey M., Cattell M., Wright J. E., Sturridge M. F., Balcon R., Layton C. Reoperation for recurrent angina. Br Heart J. 1979 Sep;42(3):333–338. doi: 10.1136/hrt.42.3.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brower R. W., Laird-Meeter K., Serruys P. W., Meester G. T., Hugenholtz P. G. Long term follow-up after coronary artery bypass graft surgery. Progression and regression of disease in native coronary circulation and bypass grafts. Br Heart J. 1983 Jul;50(1):42–47. doi: 10.1136/hrt.50.1.42. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Campeau L., Lespérance J., Hermann J., Corbara F., Grondin C. M., Bourassa M. G. Loss of the improvement of angina between 1 and 7 years after aortocoronary bypass surgery: correlations with changes in vein grafts and in coronary arteries. Circulation. 1979 Aug;60(2 Pt 2):1–5. doi: 10.1161/01.cir.60.2.1. [DOI] [PubMed] [Google Scholar]
- Chesebro J. H., Clements I. P., Fuster V., Elveback L. R., Smith H. C., Bardsley W. T., Frye R. L., Holmes D. R., Jr, Vlietstra R. E., Pluth J. R. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982 Jul 8;307(2):73–78. doi: 10.1056/NEJM198207083070201. [DOI] [PubMed] [Google Scholar]
- Chesebro J. H., Fuster V. Drug trials in prevention of occlusion of aorta--coronary artery vein grafts. J Thorac Cardiovasc Surg. 1982 Jan;83(1):90–93. [PubMed] [Google Scholar]
- Chesebro J. H., Fuster V., Elveback L. R., Clements I. P., Smith H. C., Holmes D. R., Jr, Bardsley W. T., Pluth J. R., Wallace R. B., Puga F. J. Effect of dipyridamole and aspirin on late vein-graft patency after coronary bypass operations. N Engl J Med. 1984 Jan 26;310(4):209–214. doi: 10.1056/NEJM198401263100401. [DOI] [PubMed] [Google Scholar]
- Fuster V., Chesebro J. H., Frye R. L., Elveback L. R. Platelet survival and the development of coronary artery disease in the young adult: effects of cigarette smoking, strong family history and medical therapy. Circulation. 1981 Mar;63(3):546–551. doi: 10.1161/01.cir.63.3.546. [DOI] [PubMed] [Google Scholar]
- Fuster V., Dewanjee M. K., Kaye M. P., Josa M., Metke M. P., Chesebro J. H. Noninvasive radioisotopic technique for detection of platelet deposition in coronary artery bypass grafts in dogs and its reduction with platelet inhibitors. Circulation. 1979 Dec;60(7):1508–1512. doi: 10.1161/01.cir.60.7.1508. [DOI] [PubMed] [Google Scholar]
- Harjola P. T., Frick M. H., Meurala H., Valle M. The effect of dipyridamole and warfarin on the patency rate of coronary artery bypass grafts. Thorac Cardiovasc Surg. 1983 Dec;31(6):374–376. doi: 10.1055/s-2007-1022022. [DOI] [PubMed] [Google Scholar]
- Harker L. A., Slichter S. J. Studies of platelet and fibrinogen kinetics in patients with prosthetic heart valves. N Engl J Med. 1970 Dec 10;283(24):1302–1305. doi: 10.1056/NEJM197012102832402. [DOI] [PubMed] [Google Scholar]
- Josa M., Lie J. T., Bianco R. L., Kaye M. P. Reduction of thrombosis in canine coronary bypass vein grafts with dipyridamole and aspirin. Am J Cardiol. 1981 Jun;47(6):1248–1254. doi: 10.1016/0002-9149(81)90254-x. [DOI] [PubMed] [Google Scholar]
- Mayer J. E., Jr, Lindsay W. G., Castaneda W., Nicoloff D. M. Influence of aspirin and dipyridamole on patency of coronary artery bypass grafts. Ann Thorac Surg. 1981 Mar;31(3):204–210. doi: 10.1016/s0003-4975(10)60927-7. [DOI] [PubMed] [Google Scholar]
- McEnany M. T., Salzman E. W., Mundth E. D., DeSanctis R. W., Harthorne J. W., Weintraub R. M., Gates S., Austen W. G. The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts. J Thorac Cardiovasc Surg. 1982 Jan;83(1):81–89. [PubMed] [Google Scholar]
- Metke M. P., Lie J. T., Fuster V., Josa M., Kaye M. P. Reduction of intimal thickening in canine coronary bypass vein grafts with dipyridamole and aspirin. Am J Cardiol. 1979 Jun;43(6):1144–1148. doi: 10.1016/0002-9149(79)90145-0. [DOI] [PubMed] [Google Scholar]
- Pantely G. A., Goodnight S. H., Jr, Rahimtoola S. H., Harlan B. J., DeMots H., Calvin L., Rösch J. Failure of antiplatelet and anticoagulant therapy to improve patency of grafts after coronary-artery bypass: a controlled, randomized study. N Engl J Med. 1979 Nov 1;301(18):962–966. doi: 10.1056/NEJM197911013011803. [DOI] [PubMed] [Google Scholar]
- Unni K. K., Kottke B. A., Titus J. L., Frye R. L., Wallace R. B., Brown A. L. Pathologic changes in aortocoronary saphenous vein grafts. Am J Cardiol. 1974 Oct 3;34(5):526–532. doi: 10.1016/0002-9149(74)90122-2. [DOI] [PubMed] [Google Scholar]
- Vlodaver Z., Edwards J. E. Pathologic changes in aortic-coronary arterial saphenous vein grafts. Circulation. 1971 Oct;44(4):719–728. doi: 10.1161/01.cir.44.4.719. [DOI] [PubMed] [Google Scholar]