Is Dual Antiplatelet Therapy Beneficial After Below-Knee Bypass Grafting?

A guideline from the American College of Chest Physicians (ACCP) recommends that patients receive aspirin therapy after infra-inguinal bypass surgery for peripheral arterial disease (JW Gen Med Jul 17 2008). To determine whether dual antiplatelet therapy is superior to aspirin alone, researchers in Europe and Australia randomized 851 patients who underwent unilateral below-knee bypass grafting to receive either clopidogrel (Plavix) plus aspirin or placebo plus aspirin; 70% received venous grafts, and 30% received prosthetic grafts. The trial was funded by the maker of clopidogrel.

After average follow-up of 1 year, incidence of the primary endpoint (graft occlusion, additional revascularization procedure involving the graft, above-ankle ampu…