Ticagrelor (Brilinta) is no better than aspirin—and may be worse—for adults after CABG

Reference

Schunkert H, Boening A, von Scheidt M, et al. Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial. European Heart Journal 2019;40(29):2432-2440.

Synopsis

Previous studies have reported a tendency toward higher graft patency rates in post-CABG adults with ticagrelor plus aspirin compared with aspirin alone. These investigators identified consenting adults (N = 1893), 18 years or older, with an acute coronary syndrome or stable coronary artery disease who met standard criteria for CABG surgery. Within the first 24 hours after surgery, eligible patients randomly received (concealed allocation assignment) either aspirin 100 mg once daily or ticagrelor 90 mg twice daily using a double-dummy design to mask study medication. Individuals who assessed outcomes remained masked to treatment group assignment. Complete follow-up occurred for all patients for 12 months. Using intention-to-treat analysis, the primary composite outcome of cardiovascular death, myocardial infarction, stroke and repeat revascularization occurred nonsignificantly more (since the trial was prematurely stopped) in the ticagrelor group than in the aspirin group (9.7% vs 8.2%, respectively). None of the individual components of the primary end point showed a significant difference, including the secondary outcomes of all-cause death and major bleeding events.