The Two Drug Strategy Offers Surgery Benefits

Preparation of a vein graft. Source: Shutterstock

A new analysis shows that a combination of two antiplatelet drugs may benefit patients after the most common type of heart surgery, while increasing the risk of potentially dangerous bleeding. This double-edged finding by researchers at Weill Cornell Medicine and NewYork-Presbyterian suggests that physicians should carefully evaluate the use of these drugs after this procedure.

In an analysis published in JAMA on August 9, a team led by Dr.

Mario Gaudino, https://cornellheartsurgery.org/the-two-drug-strategy/ a coronary artery bypass surgeon, examined data from 1,668 grafts in which surgeons use a piece of vein removed from the leg to bypass blocked coronary arteries. Sometimes, however, blood clots form in the transplanted vein, restricting blood flow. Patients are usually given aspirin; However, some evidence suggests that taking aspirin with a prescription antiplatelet drug, such as a B. ticagrelor, may be more effective in preventing this clotting.

“We found that this dual therapy significantly reduced blood clotting risk of graft failure. However, we have shown for the first time that this approach also carries a significant risk of clinically relevant bleeding,” said Dr.

Gaudino, Stephen and Suzanne Weiss Professor of Cardiothoracic Surgery at Weill Cornell Medicine and Cardiothoracic Surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. cornellheartsurgery “So, the benefit comes at a price.”

Taken together, these results suggest that physicians should base their decisions on the individual circumstances of the patient and avoid this approach in patients with conditions that pose a risk of bleeding. , he said.

Approximately 300,000,
patients undergo coronary artery bypass graft surgery each year to treat narrowed or blocked arteries that deprive the heart muscle of oxygen-rich blood. In more than 90% of these procedures, surgeons remove a graft from one of the patient’s saphenous veins, which carry blood through the inside of the legs.

However, up to a quarter of these grafts become blocked within a year.

A few studies have examined the benefit of giving patients aspirin and ticagrelor, an approach known as https://cornellheartsurgery.org/ dual antiplatelet therapy (DAPT). However, these studies were small and came to conflicting conclusions. The team, led by first author Dr. Sigrid Sandner, a masters student in clinical epidemiology at the Weill Cornell School of Medical Sciences, contacted researchers from four of
such studies to gain access to their data

The team then compiled this data and created a much larger study that was able to draw more robust conclusions.

They found a failure rate of about 11% in patients given a combination of Aspirin and ticagrelor were given, while constipation occurred in 20 percent of grafts when patients received only aspirin. However, compared to aspirin alone, DAPT caused more bleeding events that, although generally not life-threatening, required medical attention.

Source : https://cornellheartsurgery.org/

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