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Ticagrelor plus aspirin after CABG reduces vein graft failure but increases risk of serious bleeding
Clinical Question
Is ticagrelor plus aspirin (dual antiplatelet therapy) superior to aspirin alone for reducing adverse outcomes in adults undergoing coronary artery bypass graft surgery?
Bottom line
This review found that DAPT with ticagrelor plus aspirin compared with aspirin alone after CABG surgery reduces the risk of vein graft failure but does not reduce the risk of adverse cardiovascular events, and it increases the risk of clinically important bleeding. A previous study found no benefit to ticagrelor over aspirin alone after CABG. The best evidence continues to favor aspirin alone after CABG surgery. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
Between 10% and 25% of saphenous vein grafts used as conduits in coronary artery bypass graft (CABG) surgery occlude within the first year as a result of thrombosis. These investigators searched MEDLINE, EMBASE, and the Cochrane databases without language restrictions for randomized controlled trials that compared dual antiplatelet therapy (DAPT; ticagrelor with aspirin) versus aspirin alone in patients undergoing CABG surgery. Two individuals independently assessed studies for inclusion criteria and risk of bias using the Cochrane risk of bias tool. Conflicts were resolved after consensus agreement with a third reviewer. Four trials met inclusion criteria. Saphenous vein graft failure occurred significantly less often in the DAPT group compared with the aspirin-alone group (11.2% vs 20.0%, respectively). However, DAPT was associated with the more important patient-oriented outcomes of a higher risk of clinically important bleeding and without any significantly reduced risk of adverse cardiovascular events compared with aspirin alone.
Reviewer
David C. Slawson, MD
Professor and Vice Chair of Family Medicine for Education and Scholarship
Atrium Health
Professor of Family Medicine, UNC Chapel Hill
Charlotte, NC
Comments
Post CABG DAPT
How about clopidogrel?
Complications post CABG
Dual anti platelet therapy is not worth the risk of bleeding complications.
ticagrelor and asa post CABG
asa alone is still better and less side effects