Fellowship: Wendell Akers, Clopidogrel Administration Following OPCAB Surgery

Traditionally, cardiopulmonary bypass (CPB) has been required to perform coronary artery bypass grafting (CAB G) safely and effectively. Despite significant advancements of CPB techniques, CPB continues to be associated with significant adverse effects. Cardiac surgeons have attempted to make cardiac surgery less invasive by performing myocardial revascularization without the use of CPB. This procedure is known as off-pump coronary artery bypass (OPCAB) surgery.Traditionally, aspirin therapy Initiated within 6 hours of surgery combined with the coagulopathy from exposure to the CPB circuit has provided sufficient antiplatelet effects to offer significant protection from both early and late graft occlusion. However, following OPCAB, aspirin alone does not appear to provide the same protection. As a result of the potential decrease in graft patency following OPCAB, many surgeons have begun to explore more aggressive antiplatelet therapy with clopidogrel. However, the benefit of clopidogrel is anecdotal at best and there is no data on efficacy, safety, or optimal dosing in this patient population. We propose to evaluate the safety of clopidogrel with and without a loading dose as compared to placebo when given 6 hours after OPCAB and continued for 5 days.