**3. Methods and material**

The Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) trial demonstrated that the combination of clopidogrel and aspirin was superior to aspirin alone for patients hospitalized with non–ST-elevation ACSs.[5] The therapy was in addition to the current standard of care, including heparin or low-molecular-weight heparin, antianginal

Actually the field of the indications of use of the Clopidogrel is being continuously updated. There are different type of patients who benefit from antiplatelet therapy [16, 17] Moreover the combination of two antiagregant drugs (mainly ASA and clopidogrel) in high risk patients is a practice more and more extended [18] and dual antiplatelet therapy is recommended and

On the other hand, in patients undergoing coronary artery bypass grafting, immediate

Antiplatelet therapy is critical in the management of coronary artery disease. For patients undergoing coronary artery bypass graft surgery (CABG), controversy remains regarding the safety of preoperative antiplatelet therapy and the optimal postoperative antiplatelet regimen

Despite > 30 years of experience with antiplatelet agents during CABG, questions remain regarding their perioperative safety and efficacy. The results of continuing randomized controlled trials should further clarify the role of perioperative aspirin and clopidogrel therapy and help redefine the modern antiplatelet management of coronary artery bypass patients.

Following surgery, extensive evidence supports the use of aspirin, in doses of 100 - 325 mg daily, to be administered in 48 h postoperatively and continued indefinitely. Less is known regarding the use of clopidogrel following CABG, although it is now recommended as postoperative antiplatelet therapy in patients with recent acute coronary syndromes.[20]

It is very important to identify the optimal timing and dose ofAaspirin following CABG, and

The recommendations regarding the treatment with Clopidogrel in coronary artery sugery do not take into consideration the cost-benefit ratio which reflect the usefulness from economic

**1.** To compare the efficacy and safety of Clopidogrel with Aspirin and Aspirin plus Clopi‐ dogrel in patients undergoing surgical coronary revascularisation in the immediate postoperative period and 1 year after coronary artery bypass grafting depending on the type of the lesion, on the type of the surgical procedure and on the associated risk factors

point of view, probably because of a the complexity of factors of this equation.

has to be maintained at least 12 months after drug eluting stent placement [19].

postoperative antiagregant regimens are only regulated for routinely use Aspirin.

to maintain graft patency and reduce ischemic complications.

to assess the role of postoperative Clopidogrel therapy.

**2. Objectives**

for gastrointestinal bleeding.

therapy, and revascularization.[5, 6, 15].

292 Artery Bypass

Randomized,, open label three years clinical trial with open study period, carried out on 1200 pts undergoing coronary artery bypass grafing divided in three parallel groups: Group A: Clopidogrel po 75 mg/day, Group B: Aspirin po 75 mg/day and Group C: Aspirin 75mg plus Clopidogrel 75mg once daily.

The main phases of the study protocol were: (Figure 1)

	- **◦** Group A with Aspirin 75 mg daily
	- **◦** Goup B with Clopidogrel 75 mg daily
	- **◦** Group C with combination of Aspirin 75 mg with Clopidogrel 75 mg.

The treatment began the second day postoperatively and lasted no less than 1 year postoper‐ atively.

**•** follow –up phase – all patients were evaluated clinically and paraclinically daily for the first ten days and at one, three, six months and one year postoperatively. Patients were followed for a minimum of 1 to a maximum of 3 years, regardless of discontinuation of the study drug. Follow-up assessments took place at 1, 3, 6, and 12 months for all patients and at 1, 2 and 3 years for patients randomized early in the study.
