Original Article

Efficacy and Safety of Rivaroxaban versus Warfarin in Patients with Coronary Endarterectomy: A Cross Sectional Study

Abstract

Background: Coronary endarterectomy is an adjunctive treatment to coronary artery bypass grafting (CABG) in patients with multiple coronary involvements. The aim of the present study was to compare the efficacy and safety of the rivaroxaban versus warfarin in patients undergoing CABG endarterectomy in a prospective observational study. Methods: All the patients who had undergone CABG endarterectomy and had received rivaroxaban or warfarin during the period from January2019 until August 2020 were included in the study. Need for salvage CABG, major bleeding, and thromboembolic events were considered as primary outcomes. The secondary outcomes included all-cause mortality and minor bleeding. The patients all were followed for at least six months after their hospital discharge. Results: Out of the 73 patients recruited during the 18 months, 45 received rivaroxaban and the remaining people received warfarin along with at least one antiplatelet. During the follow-up, no salvage CABG was performed. The minor bleeding was comparable between the two groups (31.96 versus 13.27; p=0.21). There was no significant difference between warfarin and rivaroxaban in terms of major bleeding and thromboembolic events (p=0.38 and >0.99, respectively). The all-cause mortality rate was similar between the two groups (p>0.99). Conclusion: In this preliminary real-word study, rivaroxaban was comparable to warfarin in terms of efficacy and safety in the patients undergoing CABG endarterectomy. Further larger studies are needed to clarify safety and efficacy of such approach.

1. Soylu E, Harling L, Ashrafian H, Casula R, Kokotsakis J, Athanasiou T. Adjunct coronary endarterectomy increases myocardial infarction and early mortality after coronary artery bypass grafting: a meta-analysis. Interact Cardiovasc Thorac Surg. 2014;19(3):462-73.
2. Abid AR, Farogh A, Naqshband MS, Akhtar RP, Khan JS. Hospital outcome of coronary artery bypass grafting and coronary endarterectomy. Asian Cardiovasc Thorac Ann. 2009;17(1):59-63.
3. Demirtas M, Tarcan S, Sungu U. [Results of endarterectomy combined with angioplasty in aortocoronary bypass]. Ann Cardiol Angeiol (Paris). 1994;43(9):526-31.
4. Taşdemir O, Kiziltepe U, Karagöz HY, Yamak B, Korkmaz S, Bayazit K. Long-term results of reconstructions of the left anterior descending coronary artery in diffuse atherosclerotic lesions. J Thorac Cardiovasc Surg. 1996;112(3):745-54.
5. Erdil N, Cetin L, Kucuker S, Demirkilic U, Sener E, Tatar H. Closed endarterectomy for diffuse right coronary artery disease: early results with angiographic controls. J Card Surg. 2002;17(4):261-6.
6. Asimakopoulos G, Taylor KM, Ratnatunga CP. Outcome of coronary endarterectomy: a case-control study. Ann Thorac Surg. 1999;67(4):989-93.
7. Castini D, Persampieri S, Sabatelli L, et al. Utility of the HAS-BLED score for risk stratification of patients with acute coronary syndrome. Heart Vessels. 2019;34(10):1621-30.
8. Hsieh MJ, Lee CH, Chen CC, Chang SH, Wang CY, Hsieh IC. Predictive performance of HAS-BLED risk score for long-term survival in patients with non-ST elevated myocardial infarction without atrial fibrillation. J Cardiol. 2017;69(1):136-43.
9. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation. 1998;97(9):916-31.
10. Ghatanatti R, Teli A. Coronary Endarterectomy: Recent Trends. J Clin Diagn Res. 2017;11(8):Pe01-pe4.
11. Ellouze M, Bouchard D, Pham M, et al. Coronary endarterectomy in patients with diffuse coronary artery disease: assessment of graft patency with computed tomography angiography. Can J Surg. 2022;65(5):E635-e41.
12. Russo M, Nardi P, Saitto G, et al. Single versus double antiplatelet therapy in patients undergoing coronary artery bypass grafting with coronary endarterectomy: mid-term results and clinical implications. Interact Cardiovasc Thorac Surg. 2017;24(2):203-8.
13. Yan H, Tiemuerniyazi X, Song Y, Xu F, Feng W. Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study. J Thorac Cardiovasc Surg. 2020;15(1):155.
14. Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33.
15. Savi P, Pereillo J, Uzabiaga M, et al. Identification and biological activity of the active metabolite of clopidogrel. Thromb Haemost. 2000;84(11):891-6.
16. Matetzky S, Shenkman B, Guetta V, et al. Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction. Circulation. 2004;109(25):3171-5.
17. Takanashi S, Fukui T, Miyamoto Y. Coronary endarterectomy in the left anterior descending artery. J Cardiol. 2008;52(3):261-8.
18. Kyuchukov D, Zheleva-Kyuchukova I, Nachev G. Antithrombotic regimens in patients after coronary artery bypass grafting and coronary endarterectomy. Pharmacia. 2020;67:115.
19. Yan H, Tiemuerniyazi X, Song Y, Xu F, Feng W. Comparison of dual antiplatelet therapies after coronary endarterectomy combined with coronary artery bypass grafting: a cohort study. J Cardiothorac Surg. 2020;15(1):1-7.
20. Vafaey HR, Salehi Omran MT, Abbaspour S, Banihashem N, Faghanzadeh Ganji G. Anti-coagulation therapy following coronary endarterectomy in patient with coronary artery bypass graft. Caspian J Intern Med. 2018;9(1):27-31.
21. Kyuchukov D, Zheleva-Kyuchukova I, Nachev G. Antithrombotic regimens in patients after coronary artery bypass grafting and coronary endarterectomy. Pharmacia. 2020;67(3):115-120.
Files
IssueVol 11, No 3 (Summer 2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jpc.v11i3.16000
Keywords
Coronary Artery Bypass Grafting; Endarterectomy; Rivaroxaban; Warfarin

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Shahbazi F, Heydarpour F, Badrbani M, Azizi M, Kamari A, Bahremand M, Shojaei L. Efficacy and Safety of Rivaroxaban versus Warfarin in Patients with Coronary Endarterectomy: A Cross Sectional Study. J Pharm Care. 2023;11(3):158-164.