Antiplatelet or anticoagulant therapy after coronary artery bypass surgery: a meta-analysis of clinical trials

Article Abstract:

Coronary artery bypass surgery is performed to bypass blocked or narrowed coronary arteries and provide new routes for blood to reach the heart; it is done to prevent angina (chest pain) and heart attacks. One of the major complications that may follow coronary artery bypass surgery is a graft occlusion, blockage of a newly routed blood vessel. Up to 15 percent of these grafts occlude one to two weeks after surgery and up to 30 percent occlude within the first year. After one year the incidence of occlusion is reduced to about two to four percent. This study has retrospectively examined the results of thirteen clinical trials with patients who underwent coronary artery bypass surgery and were subsequently treated with antiplatelet or anticoagulant drugs to prevent occlusions. Only randomized trials that used control groups were included. Data were compiled from these different, independently conducted studies and evaluated using meta-analysis, a statistical method that addresses a single question using the combined results of several independent studies. Meta-analysis is a useful tool for evaluating the many research studies that have been done on a single topic; its goal is to reach an objective conclusion concerning the meaning of the research literature available. The statistical analysis showed that active post-surgical treatment of patients with antiplatelet or anticoagulant drugs was useful. The incidence of graft occlusion after coronary artery bypass surgery was reduced in patients treated with antiplatelet or anticoagulant drugs. Also, commencement of therapy soon after surgery was beneficial. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Evaluation, Anticoagulants (Medicine), Anticoagulants, Arterial grafts

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Surrogate end points in clinical trials: are we being misled?

Article Abstract:

Surrogate end points should not be substituted for clinical outcomes in definitive trials. It is tempting to substitute surrogate end points such as CD4 cell counts, cholesterol levels, or tumor shrinkage for clinically meaningful outcomes that measure survival or how a patient functions or feels. Trials with surrogate end points require fewer participants, shorter follow up, and cost less. However, trials using surrogate end points commonly conclude that new therapies show great promise that later turn out to be ineffective or even harmful in trials using clinical outcomes.

Physiological aspects, Diseases

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Large Pleural Effusions Occurring after Coronary Artery Bypass Grafting

Article Abstract:

Many cases of pleural effusion following cardiac bypass surgery do not have a clear cause. Researchers found that fewer than 1% of 3,707 patients developed significant accumulations of fluid around the lungs after heart surgery. Some cases were caused by congestive heart failure, pericarditis, or pulmonary embolism, but 19 of 29 cases had no apparent cause. Eleven of 19 effusions were nonbloody, and these tended to require more aggressive treatment than cases in which the pleural fluid contained blood.

United States, Causes of, Pleural effusions, Pleural effusion

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