Heart Care Info - Heart Disease Prevention & Treatment

Response to Letters Regarding Article,“Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting: The Clopidogrel After Surgery for ...

A Kulik, MR Le May, P Voisine, JC Tardif... - Circulation, 2011 - Am Heart Assoc... e195 Page 2. 2. Kulik A, Le May M, Wells GA, Mesana TG, Ruel M. The clopidogrel after surgery for coronary artery disease (CASCADE) randomized con- trolled trial: clopidogrel and aspirin versus aspirin alone after coronary bypass surgery [NCT00228423]. ... [CITATION] Insulin Secretion After Gastric Bypass Surgery: The Role of Glucagon-Like Peptide-1JJ Holst - 2011

We thank Gasparovic et al and Bisdas et al for their interest and insightful comments regarding our recently published Clopidogrel after Surgery for Coronary Artery Disease (CASCADE) study.1 CASCADE was a randomized, placebo-controlled trial that evaluated the impact of adding clopidogrel to aspirin on the process of saphenous vein graft disease after coronary artery bypass graft surgery (CABG).2 Compared with aspirin alone, the combination of aspirin plus clopidogrel did not significantly reduce vein graft intimal hyperplasia 1 year after CABG, as assessed by intravascular ultrasound. Although CASCADE was not powered for angiographic or clinical outcomes, we also did not see a significant difference in vein graft patency or cardiovascular events between the 2 treatment groups.1 As noted by Bisdas et al, 1-year vein graft patency in CASCADE was >90%, in contrast to other recently published CABG studies.3 We attribute our favorable patency data to the early administration of antiplatelet therapy on the day of surgery,2 the frequent use of lipid-lowering therapy,4 and the avoidance of endoscopic vein harvesting in the study.3

The letters by Gasparovic and Bisdas both refer to the subject of aspirin and clopidogrel resistance, a topic of intense research and debate. While designing the CASCADE Trial in 2005,2 we initially considered incorporating platelet testing into the study protocol. However, the focus of the trial was on the outcome of intimal hyperplasia, and to reduce cost and complexity, we did not include platelet response to aspirin and clopidogrel therapy as ...