Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial

J Am Coll Cardiol. 2010 Nov 9;56(20):1639-43. doi: 10.1016/j.jacc.2010.03.104.


Objectives: We sought to evaluate the effect of aspirin plus clopidogrel versus aspirin alone on saphenous vein graft occlusion at 3 months after coronary artery bypass grafting (CABG).

Background: Prevalence of graft occlusion is high after CABG. Aggressive antiplatelet therapy is expected to improve early post-operative graft patency.

Methods: From December 2007 through December 2008, 249 consecutive patients undergoing elective CABG at Fuwai Hospital were randomly assigned to 2 groups: 124 received aspirin (100 mg) plus clopidogrel (75 mg) daily (AC group), and 125 received aspirin (100 mg) alone daily (A group). Antiplatelet therapies were initiated when post-operative chest tube drainage was ≤ 30 cc/h for 2 h. All participants were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis at 3 months post-operatively. Generalized estimating equations analysis was used to determine predictors of graft patency.

Results: One participant, from group A, died before 3-month follow-up. Of the remaining 248 patients, 224 (90.3%) underwent MSCTA. Participants had similar pre-operative and intraoperative characteristics at baseline. No significant differences were observed in intraoperative transit-time flow measurement findings or major adverse cardiac-related events. Three-month MSCTA follow-up revealed that saphenous vein graft patency was 91.6% (219 of 239) in the AC group versus 85.7% (198 of 231) in the A group (p = 0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency (p = 0.045).

Conclusions: Aspirin plus clopidogrel is more effective in venous graft patency than aspirin alone in the short term after CABG, but further, long-term study is needed. (The Clopidogrel and Aspirin After Surgery for Coronary Artery Disease; NCT00776477).

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Oral
  • Aspirin / administration & dosage
  • Aspirin / therapeutic use*
  • Clopidogrel
  • Coronary Angiography
  • Coronary Artery Bypass / methods*
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / therapy*
  • Drug Therapy, Combination
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / prevention & control*
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / therapeutic use
  • Prospective Studies
  • Saphenous Vein / physiopathology
  • Saphenous Vein / transplantation*
  • Ticlopidine / administration & dosage
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use
  • Time Factors
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Vascular Patency / drug effects*
  • Vascular Patency / physiology


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • Ticlopidine
  • Aspirin

Associated data