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Effect Of Adding Clopidogrel To Aspirin On The Success Of Below Knee Arterial Bypass Grafts. A Randomised Placebo Controlled Study

John Dormandy¹, Jill Belch², on behalf of the CASPAR investigators.
¹St George's Hospital School of Medicine, London, United Kingdom; ²University of Dundee School of Medicine, Dundee, United Kingdom.

OBJECTIVES: The CASPAR trial investigated whether adding clopidogrel (C) to acetyl salicylic acid (ASA) after surgery for below-knee bypass graft prevents occlusion, revascularization or replacement of the graft, and improves limb salvage and survival.

METHODS: Patients were randomized to receive C 75mg o.d. or placebo (P) on a background of ASA 75-100 mg o.d., within 4 days of a successful surgery. Randomization was stratified according to the type of graft (venous or prosthetic).

RESULTS: 598 and 253 patients from 14 countries had venous and prosthetic grafts, respectively. The distal anastomosis was to the popliteal (75.2%) or to a more distal artery (24.8%). The median treatment duration was 356 and 340 days in the P and the C group, respectively. There was a significant interaction between treatment and type of graft (p=0.008) Table 1. The rates of cardiovascular death, myocardial infarction or stroke were similar in the P and C groups, 28 and 30 patients, respectively. Five (1.2%) and 9 (2.1%) patients had severe bleeding episodes in the P and C groups.

CONCLUSIONS: The addition of C to ASA significantly improves the outcomes of prosthetic graft.