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Dual Antiplatelet Therapy versus Aspirin Monotherapy after CABG: short and long-term survival
Session:
Painel 11 -Cardiologia Intervenção 1
Speaker:
João Rocha-Gomes
Congress:
CPC 2020
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
26.1 Cardiovascular Surgery – Coronary Arteries
Session Type:
Posters
FP Number:
---
Authors:
João Rocha-Gomes; Francisca Saraiva; Rui Cerqueira; Raquel Moreira; Ana Filipa Ferreira; Mário Jorge Amorim; Paulo Pinho; André Lourenço; Adelino Leite-Moreira
Abstract
<p><strong>Background</strong>: There is currently conflicting evidence regarding dual antiplatelet therapy’s (DAPT) security profile and the outcomes of this pharmacological regimen in patients undergoing CABG.</p> <p><strong>Aim:</strong> We aim to compare the effect of early DAPT in short and long-term survival versus aspirin in a monotherapy regimen (ASA). Therapy’s safety was evaluated through early mortality and bleeding outcomes.</p> <p><strong>Methods:</strong> Single-center retrospective cohort study, on consecutive patients undergoing 1st isolated CABG surgery in 2010. Pre-, peri- and postoperative data were collected through clinical files and informatics databases. The DAPT and ASA groups were defined considering the institution of clopidogrel plus aspirin and only aspirin, respectively, within a 24h window after surgery. T-tests and Pearson’s chi-squared tests were used for group comparison. Survival analysis was performed using Kaplan-Meier curves compared through Log-Rank test and multivariable Cox regression. Propensity scores (PS) were estimated using a multivariable logistic regression and included in multivariable regressions as a covariate along with DAPT. Median follow-up time was 9 years. Early mortality was defined if occurred before discharge or within the 30 days following the surgery; bleeding was assessed through red blood cells (RBC) transfusion, re-exploration of thorax and drainage.<br /> <br /> <strong>Results</strong>: We included 351 patients and DAPT was performed in 251 patients (71.5%). Mean patient’s age was 64±10 years and 81% were male. DAPT patients were younger (63±10 vs. 66±10 years, p=0.007) but DAPT and ASA groups were similar regarding the cardiovascular modifiable risk factors. Kaplan-Meier curves showed similar cumulative survival between groups (75% in DAPT vs. 67% in ASA group, Log-rank p=0.103), as well as the PS adjusted analysis (HR DAPT: 0.928, 95%CI: 0.570-1.513). Regarding safety outcomes, we found no differences in early mortality (one patient per group, p=0.489). Aligned with the similar post-operative total median drainage (1220mL in DAPT vs. 1300mL in ASA, p=0.490), the total median cell-saver transfusion (300mL vs. 250mL, p=0.318) and the re-exploration of thorax due to bleeding (1.6% vs. 4% p=0.231) showed no statistical significance either. However, there was a lower frequency of DAPT patients requiring 3 or more peri and postoperative RBC transfusions (8.5% vs. 13.3% p<0.001 and 4.8% vs. 13%, p=0.009, respectively). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA), during follow-up.<br /> <br /> <strong>Conclusion:</strong> Compared with ASA, DAPT showed non-significant impact in long-term survival but demonstrated to be a safe option within the assessed bleeding outcomes. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.</p>
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