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Clopidogrel Treatment and the MEND-CABG II Trial—Reply
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In Reply: We share the interest of Dr Oh and colleagues in the use of clopidogrel and its relationship to both hemorrhagic and ischemic outcomes in patients undergoing CABG surgery. As they point out, the risks and benefits of clopidogrel before and after CABG surgery are controversial and poorly understood.1 Current guidelines from the American College of Cardiology and American Heart Association recommend discontinuing clopidogrel several days before CABG surgery and restarting it postoperatively for up to a year in patients with recent acute coronary syndromes.2
In MEND-CABG II, the use of clopidogrel was similar between patients assigned to MC-1 and placebo within the week prior to surgery and postoperatively (Table). The 29% rate of use prior to surgery is consistent with the 29% of patients enrolled in MEND-CABG II who had had an MI during the 6 weeks before surgery.3
Table appears in full text version.
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Table. Use of Clopidogrel in MEND-CABG II
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. . . [Full Text of this Article]
John H. Alexander, MD, MHS
john.h.alexander@duke.edu
Stephen J. Ellis, PhD
Duke Clinical Research Institute
Durham, North Carolina
Jean-Claude Tardif, MD
Montreal Heart Institute
Montreal, Quebec, Canada
RELATED ARTICLE
Efficacy and Safety of Pyridoxal 5'-Phosphate (MC-1) in High-Risk Patients Undergoing Coronary Artery Bypass Graft Surgery: The MEND-CABG II Randomized Clinical Trial
MEND-CABG II Investigators*
JAMA. 2008;299(15):1777-1787.
ABSTRACT
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RELATED LETTER
Clopidogrel Treatment and the MEND-CABG II Trial
Jaewon Oh, Namki Hong, and Seok-Min Kang
JAMA. 2008;300(9):1021.
EXTRACT
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