Perioperative antiplatelet therapy for aortocoronary artery bypass surgery

The dipyridamole and aspirin therapy outlined in the table is standard at the Mayo Clinic and Mount Sinai Hospitals for patients undergoing aortocoronary vein bypass operations. For patients who are allergic to or intolerant of aspirin or who have had previous gastrointestinal bleeding or gastric ulcer, there are two empiric alternatives: continue dipyridamole, 100 mg four times daily, without aspirin after operation, or use sulfinpyrazone, 200 mg four times daily, beginning 1 or 2 days before operation and continuing on the day of and after operation (one trial showing favorable benefit has been discussed). Platelt inhibitor therapy should be continued for at least one year and perhaps indefinitely, as suggested by the decreased lipid incorporation into vein grafts after administration of dipyridamole and aspirin in nonhuman primates. The ultimate results of our ongoing trial in the prevention of angiographic progression of coronary artery disease over 5 years in patients treated with dipyridamole and aspirin but without aortocoronary bypass surgery should also be helpful in determining whether therapy should be continued indefinitely.