Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: Results of a Veterans Administration Cooperative Study

Steven Goldman, J. Copeland, T. Mortiz, W. Henderson, K. Zadina, T. Ovitt, J. Doherty, R. Read, E. Chesler, Y. Sako, L. Lancaster, R. Emery, G. V R K Sharma, M. Josa, I. Pacold, A. Montoya, D. Parikh, G. Sethi, J. Holt

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Abstract

To determine whether specific antiplatelet therapies improved vein graft patency after coronary artery bypass grafting (CABG) we compared (1) aspirin, 325 mg daily, (2) aspirin 325 mg three times daily, (3) aspirin plus dipyridamole (325 mg and 75 mg, respectively, three times daily), (4) sulfinpyrazone (267 mg three times daily), and (5) placebo (three times daily). Therapy, except aspirin, was started 48 hr before CABG. When aspirin was a treatment, one 325 mg dose was given 12 hr before surgery and therapy and was maintained thereafter according to the assigned regimen. Angiographic graft patency data were obtained within 60 days of surgery. Analysis of early graft patency in 555 patients (1781 grafts), revealed the following graft patency rates: aspirin daily, 93.5%; aspirin three times daily, 92.3%; aspirin and dipyridamole, 91.9%; and sulfinpyrazone, 90.2%. All aspirin-containing therapeutic regimens improved (p < .05) graft patency compared with placebo (85.2%). Chest tube drainage measured within the first 35 hr after CABG revealed that the median loss with aspirin daily (965 ml), aspirin three times daily (1175 ml), and aspirin plus dipyridamole (1000 ml) exceeded (p < .02) that with placebo (805 ml), while median loss with sulfinpyrazone (775 ml) did not. The reoperation rate was greater (p < .01) in all the treatment groups that received aspirin (6.5%) compared with the two nonaspirin groups (1.7%). Overall operative mortality was 2.3%, without significant differences among treatment groups. Transient renal insufficiency occurred in 5.3% of patients taking sulfinpyrazone. Thus, early vein graft patency was improved after CABG with all aspirin-containing drug regimens. However, aspirin also increased blood loss and the rate of reoperation after CABG.

Original languageEnglish (US)
Pages (from-to)1324-1332
Number of pages9
JournalCirculation
Volume77
Issue number6
StatePublished - 1988
Externally publishedYes

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United States Department of Veterans Affairs
Saphenous Vein
Coronary Artery Bypass
Aspirin
Transplants
Sulfinpyrazone
Therapeutics
Dipyridamole
Placebos
Reoperation
Veins
Chest Tubes
Ambulatory Surgical Procedures

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy : Results of a Veterans Administration Cooperative Study. / Goldman, Steven; Copeland, J.; Mortiz, T.; Henderson, W.; Zadina, K.; Ovitt, T.; Doherty, J.; Read, R.; Chesler, E.; Sako, Y.; Lancaster, L.; Emery, R.; Sharma, G. V R K; Josa, M.; Pacold, I.; Montoya, A.; Parikh, D.; Sethi, G.; Holt, J.

In: Circulation, Vol. 77, No. 6, 1988, p. 1324-1332.

Research output: Contribution to journalArticle

Goldman, S, Copeland, J, Mortiz, T, Henderson, W, Zadina, K, Ovitt, T, Doherty, J, Read, R, Chesler, E, Sako, Y, Lancaster, L, Emery, R, Sharma, GVRK, Josa, M, Pacold, I, Montoya, A, Parikh, D, Sethi, G & Holt, J 1988, 'Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: Results of a Veterans Administration Cooperative Study', Circulation, vol. 77, no. 6, pp. 1324-1332.
Goldman, Steven ; Copeland, J. ; Mortiz, T. ; Henderson, W. ; Zadina, K. ; Ovitt, T. ; Doherty, J. ; Read, R. ; Chesler, E. ; Sako, Y. ; Lancaster, L. ; Emery, R. ; Sharma, G. V R K ; Josa, M. ; Pacold, I. ; Montoya, A. ; Parikh, D. ; Sethi, G. ; Holt, J. / Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy : Results of a Veterans Administration Cooperative Study. In: Circulation. 1988 ; Vol. 77, No. 6. pp. 1324-1332.
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abstract = "To determine whether specific antiplatelet therapies improved vein graft patency after coronary artery bypass grafting (CABG) we compared (1) aspirin, 325 mg daily, (2) aspirin 325 mg three times daily, (3) aspirin plus dipyridamole (325 mg and 75 mg, respectively, three times daily), (4) sulfinpyrazone (267 mg three times daily), and (5) placebo (three times daily). Therapy, except aspirin, was started 48 hr before CABG. When aspirin was a treatment, one 325 mg dose was given 12 hr before surgery and therapy and was maintained thereafter according to the assigned regimen. Angiographic graft patency data were obtained within 60 days of surgery. Analysis of early graft patency in 555 patients (1781 grafts), revealed the following graft patency rates: aspirin daily, 93.5{\%}; aspirin three times daily, 92.3{\%}; aspirin and dipyridamole, 91.9{\%}; and sulfinpyrazone, 90.2{\%}. All aspirin-containing therapeutic regimens improved (p < .05) graft patency compared with placebo (85.2{\%}). Chest tube drainage measured within the first 35 hr after CABG revealed that the median loss with aspirin daily (965 ml), aspirin three times daily (1175 ml), and aspirin plus dipyridamole (1000 ml) exceeded (p < .02) that with placebo (805 ml), while median loss with sulfinpyrazone (775 ml) did not. The reoperation rate was greater (p < .01) in all the treatment groups that received aspirin (6.5{\%}) compared with the two nonaspirin groups (1.7{\%}). Overall operative mortality was 2.3{\%}, without significant differences among treatment groups. Transient renal insufficiency occurred in 5.3{\%} of patients taking sulfinpyrazone. Thus, early vein graft patency was improved after CABG with all aspirin-containing drug regimens. However, aspirin also increased blood loss and the rate of reoperation after CABG.",
author = "Steven Goldman and J. Copeland and T. Mortiz and W. Henderson and K. Zadina and T. Ovitt and J. Doherty and R. Read and E. Chesler and Y. Sako and L. Lancaster and R. Emery and Sharma, {G. V R K} and M. Josa and I. Pacold and A. Montoya and D. Parikh and G. Sethi and J. Holt",
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T1 - Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy

T2 - Results of a Veterans Administration Cooperative Study

AU - Goldman, Steven

AU - Copeland, J.

AU - Mortiz, T.

AU - Henderson, W.

AU - Zadina, K.

AU - Ovitt, T.

AU - Doherty, J.

AU - Read, R.

AU - Chesler, E.

AU - Sako, Y.

AU - Lancaster, L.

AU - Emery, R.

AU - Sharma, G. V R K

AU - Josa, M.

AU - Pacold, I.

AU - Montoya, A.

AU - Parikh, D.

AU - Sethi, G.

AU - Holt, J.

PY - 1988

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N2 - To determine whether specific antiplatelet therapies improved vein graft patency after coronary artery bypass grafting (CABG) we compared (1) aspirin, 325 mg daily, (2) aspirin 325 mg three times daily, (3) aspirin plus dipyridamole (325 mg and 75 mg, respectively, three times daily), (4) sulfinpyrazone (267 mg three times daily), and (5) placebo (three times daily). Therapy, except aspirin, was started 48 hr before CABG. When aspirin was a treatment, one 325 mg dose was given 12 hr before surgery and therapy and was maintained thereafter according to the assigned regimen. Angiographic graft patency data were obtained within 60 days of surgery. Analysis of early graft patency in 555 patients (1781 grafts), revealed the following graft patency rates: aspirin daily, 93.5%; aspirin three times daily, 92.3%; aspirin and dipyridamole, 91.9%; and sulfinpyrazone, 90.2%. All aspirin-containing therapeutic regimens improved (p < .05) graft patency compared with placebo (85.2%). Chest tube drainage measured within the first 35 hr after CABG revealed that the median loss with aspirin daily (965 ml), aspirin three times daily (1175 ml), and aspirin plus dipyridamole (1000 ml) exceeded (p < .02) that with placebo (805 ml), while median loss with sulfinpyrazone (775 ml) did not. The reoperation rate was greater (p < .01) in all the treatment groups that received aspirin (6.5%) compared with the two nonaspirin groups (1.7%). Overall operative mortality was 2.3%, without significant differences among treatment groups. Transient renal insufficiency occurred in 5.3% of patients taking sulfinpyrazone. Thus, early vein graft patency was improved after CABG with all aspirin-containing drug regimens. However, aspirin also increased blood loss and the rate of reoperation after CABG.

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