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Should I be on aspirin, Plavix, or warfarin (Coumadin) after bypass surgery of an artery in my leg?

Henry I. Bussey, Pharm.D., FCCP, FAHA
October, 2005

Bypass surgery is used when the flow of blood through an artery is blocked. When bypass surgery is performed, a graft is used to create a new channel for blood to flow around the existing blockage. The graft runs the risk of becoming blocked, as well. There is a good deal of controversy as to the best way to keep bypass grafts in the leg from becoming blocked, and the recommendations vary depending on the type and location of the graft and what other risk factors the patient has. In most cases, aspirin, Plavix, or the combination of aspirin and Plavix are the medications of choice. However, for patients at high risk of blockage of the graft, the combination of warfarin (brand name Coumadin) and aspirin has been recommended by the American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy, which is the group that sets standards for care in this field. The reference for those recommendations is Clagett GP, Sobel M, Jackson MR, et al. Antithrombotic Therapy in Peripheral Arterial Occlusive Disease. Chest 2004; 126:609s-626s. This reference is available online at http://www.chestjournal.org/cgi/content/full/126/3_suppl/609S.

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