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Background:
Dual antiplatelet agents have been main stay for prevention of stent thrombosis in patients with drug-coated stents. Coronary bypass surgery with discontinuation of dual antiplatelet agents leads to increase bleeding complications. This study was designed to examine effect of dual antiplatelet agents on Robotic assisted Minimally invasive direct coronary artery bypass grafting (MIDCAB)
Methods:
From January 2010 to November 2011, 110 patients underwent robotic assisted MIDCAB at single institution. Fifty-three patients were on aspirin only or no antiplatelet agents until surgery and 57 patients were on dual antiplatelet agents (aspirin and Clopidogrel or Effient) all patients had robotic assisted internal mammary artery mobilization followed by direct bypass to anterior wall vessels via small thoracotomy. The intraoperative and postoperative outcomes were collected prospectively and were analyzed retrospectively.
Results:
Use of blood or blood products and post-operative drainage was not significantly different between two groups as shown in table.
Conclusions:
Continuation of dual antiplatelet agents does significantly increase postoperative drainage or blood and blood product requirement in patients undergoing robotic assisted MIDCAB. Patients undergoing reverse hybrid revascularization (stent first followed by CABG) should not have dual antiplatelet agents discontinued.

Variable	Single or no antiplatelet N=53	Dual antiplatelet N=57	Statistical significance
Chest tube drainage in mls	528	553	0.438
PRBC transfusion	1%	0.91%	NS
FFP transfusion	0.02%	0.05%	NS
Platelet transfusion	0.1%	0.07%	NS
Operative time in mins	203	192	NS