Doble terapia antiagregante en el postoperatorio de cirugía coronaria: revisión bibliográfica

Abstract

IntroductionExtensive and early use of acetyl-salicylic acid (ASA) is widely accepted in the post-operative period after coronary artery bypass grafting surgery (CABG), however, its combination in double antiplatelet therapy (DAT) is still controversial. DAT may improve coronary graft patency due to a lower vulnerability against constitutive and/or transient antiplatelet therapy resistance, and due to potential pleiotropic effects against intimal hyperplasia. Nevertheless, dosage and duration of the treatment are not completely established. MethodsSystematic bibliographic review in Medline combining 3 clusters of key words and stepwise selection of articles obtained. ResultsOut of a total of 56 preliminary studies found, 19 were chosen for analysis, of which 7 were randomised controlled trials, 2 meta-analyses, 1 literature review, 3 clinical guidelines, and 6 non-randomised studies. All of them were individually analysed and classified as favourable or not to DAT. ConclusionsThere is not enough evidence to warrant extensive use of DAT after CABG. However, DAT could show a benefit in certain clinical scenarios, such as CABG after prior coronary acute syndrome, extensive use of venous grafts, or CABG off-pump. The benefits shown in studies favourable to DAT on the improvement of coronary graft patency in the short-midterm did not lead to differences in the incidence of major cardiovascular events. Neither of the groups showed differences in terms of safety related to haemorrhagic events, nor in the immediate postoperative or follow-up period