Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis

Abstract

Abstract Introduction: Currently the basis of acute coronary syndrome (ACS) therapy is dual antiplatelet therapy (DAPT) with Aspirin as a nonsteroidal anti-inflammatory drug and clopidogrel as adenosine diphosphate receptor antagonists. Therefore, the aim of the present systematic review is to answer that should DAPT with Aspirin and clopidogrel be continue until coronary artery bypass grafting (CABG) in patients who have ACS? Methods: The search for relevant studies in the present meta-analysis is based on three approach: A) systematic searches in electronic databases, B) manual searches in Google and Google Scholar and C: screening of bibliography of related original and review articles. The endpoints included mortality rate, myocardial infarction (MI), cerebrovascular accident (CVA), reoperation, re-exploration, other cardiac events, renal failure, length of ICU and hospital stay, chest tube drainage and blood product transfusion after CABG. Results: After the initial screening, 41 studies were studied in detail and finally the data of 15 studies were included in the meta-analysis. DAPT before CABG in patients with ACS does not increase rate of mortality, CVA, renal failure, MI, and other cardiac events but increase reoperation, re-exploration, length of ICU and hospital stay. Chest tube drainage and blood product transfusion rate in the DAPT compared to control group (non-antiplatelet or Aspirin alone) significantly increased. Increasement in chest tube drainage and blood product transfusion rate indicates increase in bleeding, so increase in reoperation, re-exploration to control bleeding and subsequently increase in length of ICU and hospital stay is expected. Conclusions:Â DAPT with Aspirin and clopidogrel before CABG in patients with ACS does not increase the rate of mortality, CVA, renal failure, MI, and other cardiac events despite more bleedings, and it may be suggested before CABG for better graft patency.

Keywords

• Dual Anti-Platelet Therapy
• Coronary Artery Bypass
• acute coronary syndrome
• Aspirin
• clopidogrel