Abstract
The effect of the anti-platelet drug Ticlopidine (T) on the thrombotic occlusion rate of coronary artery bypass (CABP) was studied by angiography 3 months postoperatively in 237 patients. A double blind trial with T 250 mg b.i.d. or Placebo (PI) administered pre- and postoperatively with additional anticoagulation with Acenocoumarol postoperatively had to be interrupted prematurely when it became clear that T enhanced bleeding and the number of reoperations for hemostasis significantly. In the 87 patients included the number of perioperative infarctions was significantly reduced in patients receiving T (1/45) as compared to those receiving PI (6/42) P = 0,450. After three months there was no significant difference in patency rate between the two treatment groups.
After a report on a significant reduction of graft occlusion by oral anticoagulation the question arose, whether simultaneous Acenocoumarol treatment concealed a beneficial effect of T in our patients. In a prospective randomized trial on 148 patients receiving T (250 mg b.i.d.) or anticoagulation by Acenocoumarol from the second or third postoperative day on it was examined, whether T is superior, equal or inferior to oral anticoagulants regarding CABP obstruction. Three months postoperatively angiography revealed an average patency rate of 84,2 % after T as compared to 81.6 after Acenocoumarol (n.s.). Progression of stenosis in the native vessels was almost identical in both treatment groups. No side effects were observed which resulted in irreversible sequelae. Conclusions: In spite of the significant reduction of perioperative infarctions T can not be recommended preoperatively because of the significant increase of bleeding and reoperations for hemostasis. With postoperative administration T is easier to handle (standard dosage without determination of prothrombine time) and regarding CABP patency rate at least as effective as anticoagulation by Acenocoumarol.
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© 1985 Martinus Nijhoff Publishers, Dordrecht
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Rothlin, M.E. (1985). Platelet Inhibitors or Anticoagulants for Prevention of Aorto-Coronary Bypass Graft Occlusion. In: Mathes, P. (eds) Secondary Prevention in Coronary Artery Disease and Myocardial Infarction. Developments in Cardiovascular Medicine, vol 48. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-5024-5_12
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DOI: https://doi.org/10.1007/978-94-009-5024-5_12
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