**11. Study limitations**

constructed grafts would be nearly 'immune' to thrombosis, even without antiplatelet therapy. However, it could theoretically reduce the risk for early vein graft failure, which is predomi‐

There are three different principal mechanisms that play a role in vein graft failure during postoperative periods: early (<1 month): thrombosis; related to technical factors, Intermediate (1 to 12 months): intimal hyperplasia and Later postoperative (>12 months): accelerated

Concern about possible hemorrhagic complications arising from use of oral antiplatelet agents in immediate proximity to coronary artery bypass graft (CABG) surgery leads many clinicians to avoid or discontinue these agents preoperatively. Recent evidence suggests that.the modest hemorrhagic risk may be acceptable, given the clinical benefits of sustained antiplatelet therapy in preventing graft occlusion and ischemic complications pre- and post-CABG. [35] Also, other analysis provide insight into patterns of clopidogrel use and outcomes in the setting of CABG performed on patients with NSTE ACS [36] and found that as many as 30% of patients currently receive clopidogrel before CABG surgery, and, of these, nearly 90% have surgery within 5 days of treatment, contrary to the ACC/AHA guidelines recommendations. These data demonstrating a modest increase in transfusion risk in part reflect a more stable estimate

The benefits versus risks of early and long-term clopidogrel therapy (freedom from CV death, MI, stroke, or life-threatening bleeding) were similar in those undergoing revascularization (CABG or PCI) and in the study population as a whole. Overall, the benefits of starting clopidogrel on admission appear to outweigh the risks, even among those who proceed to

Data from the Antiplatelet Trialists' Collaboration support the use of antiplatelet therapy (mostly data for aspirin) after CABG and further data support the initiation of aspirin within 48 hours of CABG. The CURE trial provides the opportunity to explore the combined use of

Clopidogrel offers multiple advantages in acute and chronic use in coronary intervention. The favorable benefit/risk ratio of clopidogrel over aspirin established by CAPRIE, combined with its characteristics related to rapid onset of action, loading dose, pre-treatment efficacy and ease of use, justify the consideration of using clopidogrel in a wide range of at risk patients and in

Combined antiplatelet therapy employing agents from different pharmacological classes after CABG was characterised by good safety and efficacy profiles. The absence of interaction, and the potential synergistic effect when used with other antithrombotic agents, will allow clinicians to optimise treatment in acute situations. Combination therapy, using clopidogrel and other drugs commonly administered for a range of cardiovascular and other disorders,

Despite routine use of ASA before CABG, and lifelong following the revascularization, patients who undergo CABG remain at high risk of long-term events in any vascular

long-term prevention in various manifestations of atherosclerosis / atherothrombosis.

of risks based on a much larger case sample in the CRUSADE Initiative.

CABG during the initial hospitalization.[26]

appears safe after CABG.

aspirin and clopidogrel for those undergoing CABG.[26]

nantly thrombosis related.

atherosclerosis [34]

308 Artery Bypass

First, our comparisons of clinical outcomes by treatment strategy were observational. Al‐ though we adjusted all comparisons for baseline clinical factors, we cannot exclude any persistent unmeasured confounding. Nonetheless, because a randomized clinical trial evaluating the benefits and risks of different antiagregant regimen of patients undergoing CABG is unlikely to be undertaken, this study is the first to provide insight into the scope of this issue at a national level.we considered the diagnostic of ischemia using stress test, Holter monitoring and, in case of a positive result, invasive coronarography as sufficient. Second, we did not collect data on the incidence of re-exploration at 2 or three years after CABG, although we had some information about that and we did nor perform routinely coronarography at 1 year postoperatively to all patients.
