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

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 s...

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Autores principales: Sadeghi, Roxana, Babahajian, Asrin, Sarveazad, Arash, Kachoueian, Naser, Bahardoust, Mansour
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Shahid Beheshti University of Medical Sciences 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305656/
https://www.ncbi.nlm.nih.gov/pubmed/32613203
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author Sadeghi, Roxana
Babahajian, Asrin
Sarveazad, Arash
Kachoueian, Naser
Bahardoust, Mansour
author_facet Sadeghi, Roxana
Babahajian, Asrin
Sarveazad, Arash
Kachoueian, Naser
Bahardoust, Mansour
author_sort Sadeghi, Roxana
collection PubMed
description 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 continued 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 approaches: 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 articles 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 the rate of mortality, CVA, renal failure, MI, and other cardiac events, but increases reoperation, re-exploration, length of ICU, and hospital stay. Chest tube drainage and blood product transfusion rate significantly increased in the DAPT group compared to the control group (non-antiplatelet or Aspirin alone). Increase in chest tube drainage and blood product transfusion rate indicates an increase in bleeding, so increase in reoperation, re-exploration to control bleeding, and, subsequently, increase in the length of ICU and hospital stay are expected. CONCLUSIONS: 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.
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spelling pubmed-73056562020-06-30 Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis Sadeghi, Roxana Babahajian, Asrin Sarveazad, Arash Kachoueian, Naser Bahardoust, Mansour Arch Acad Emerg Med Review Article 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 continued 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 approaches: 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 articles 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 the rate of mortality, CVA, renal failure, MI, and other cardiac events, but increases reoperation, re-exploration, length of ICU, and hospital stay. Chest tube drainage and blood product transfusion rate significantly increased in the DAPT group compared to the control group (non-antiplatelet or Aspirin alone). Increase in chest tube drainage and blood product transfusion rate indicates an increase in bleeding, so increase in reoperation, re-exploration to control bleeding, and, subsequently, increase in the length of ICU and hospital stay are expected. CONCLUSIONS: 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. Shahid Beheshti University of Medical Sciences 2020-05-31 /pmc/articles/PMC7305656/ /pubmed/32613203 Text en This is an Open Access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Sadeghi, Roxana
Babahajian, Asrin
Sarveazad, Arash
Kachoueian, Naser
Bahardoust, Mansour
Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title_full Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title_fullStr Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title_full_unstemmed Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title_short Dual Antiplatelet Therapy before Coronary Artery Bypass Grafting; a Systematic Review and Meta-Analysis
title_sort dual antiplatelet therapy before coronary artery bypass grafting; a systematic review and meta-analysis
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305656/
https://www.ncbi.nlm.nih.gov/pubmed/32613203
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