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    Use of Clopidogrel Post-Coronary Artery Bypass Surgery in Canadian Patients With Acute Coronary Syndromes

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    Authors
    Krimly, Ahmed
    Yan, Raymond T.
    Yan, Andrew T.
    DeYoung, J. Paul
    Gallo, Richard
    Steg, Gabriel
    Eikelboom, John
    Gore, Joel M.
    Fox, Keith A. A.
    Fitchett, David
    Quantz, Mackenzie A.
    Goodman, Shaun G.
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    UMass Chan Affiliations
    Department of Medicine, Division of Cardiovascular Medicine
    Center for Outcomes Research
    Document Type
    Journal Article
    Publication Date
    2011-08-27
    Keywords
    Acute Coronary Syndrome
    Coronary Artery Bypass
    Ticlopidine
    Health Services Research
    
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    Link to Full Text
    http://dx.doi.org/10.1016/j.cjca.2011.06.003
    Abstract
    BACKGROUND: Randomized trials have established the efficacy of clopidogrel in acute coronary syndromes (ACS). The benefit of clopidogrel has also been observed in the subgroup of ACS patients who subsequently undergo coronary artery bypass surgery (CABG); however, this therapy is discontinued preoperatively and the frequency with which clopidogrel is restarted post-CABG is unknown. METHODS: We examined the pattern of clopidogrel use in the Canadian Global Registry of Acute Coronary Events (GRACE), GRACE2, and CANRACE (2003-2008) post-CABG ACS patients. We stratified the patients according to whether they underwent CABG during their index hospitalization for ACS and whether they were prescribed clopidogrel at discharge. RESULTS: Among those patients in whom clopidogrel status at discharge was known, 5904 (60%) of 9841 were discharged from hospital on clopidogrel. Use of clopidogrel at discharge was observed in 2222 (40.8%) of 5443 patients who were medically managed (ie, did not undergo percutaneous coronary intervention [PCI] or CABG) and in 3585 (90.1%) of 3980 patients who underwent in-hospital PCI. Overall, 455 (3.3%) of 13,776 patients underwent CABG during the index hospitalization; 255 (56%) patients were started on clopidogrel during the first 24 hours, and 66 of these patients (25.9%) were discharged on clopidogrel. In contrast, 5681 (61.3%) of the 9262 patients who did not undergo in-hospital CABG were discharged on clopidogrel. CONCLUSIONS: Although current guidelines recommend the use of clopidogrel post-CABG in patients with ACS, our observations suggest that only 1 in 4 or 5 Canadian patients are discharged on this therapy.
    Source
    Can J Cardiol. 2011 Aug 27. [Epub ahead of print]
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/27268
    PubMed ID
    21875778
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