Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Parolari and colleagues propose that early VGF may result from coagulation perturbations following cardiopulmonary bypass or cardiac surgery itself. Early VGF has largely been attributed to technical and flow-related factors; however, the systemic and perhaps local perturbations of platelet hemostasis and coagulation that occur with cardiac surgery also may be important.1 Despite limited randomized clinical trial data supporting efficacy (or safety), dual antiplatelet therapy was used postoperatively in almost 20% of the PREVENT IV participants and was associated with a modestly higher unadjusted rate of VGF than aspirin alone (51% vs 42%; χ2P = .002). We support the need for additional research and adequately powered clinical trials on safer, more effective antithrombotic regimens before, during, and after CABG surgery to improve graft patency and more importantly to reduce ischemic and hemorrhagic clinical events.
Alexander JH, Harrington RA, Ferguson TB, Peterson ED, Gibson CM, Kouchoukos NT, PREVENT IV Investigators FT. Efficacy and Safety of Edifoligide—Reply. JAMA. 2006;295(13):1513-1515. doi:10.1001/jama.295.13.1514-b