Dual-Antiplatelet Therapy vs Single Antiplatelet Therapy after Coronary Artery Bypass Grafting : Meta-Analysis of Randomized Controlled Trails

Introduction: Every year, around 400,000 patients in the United States and Europe undergo CABG surgery. The risks and benefits of antiplatelet regimens in these patients have been studied in various trials. In patients with a stable clinical state, aspirin monotherapy is the recommended standard of care. The present systematic literature review and meta-analysis is aimed to compare the efficacy between Dual Antiplatelet Therapy (DAPT) and Single Antiplatelet Therapy (SAPT) after CABG. Method:We searched PubMed/Medline, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) for relevant published Randomized Controlled Trials (RCTs). In total, 2,152 studies from PubMed, Science Direct and Scholar were obtained and screened for the relevance of our topic for the last 10 years (2014 to 2024), in which 18 studies passed after the inclusion and exclusion criteria using PRISMA. Result: We included 18 randomized controlled trial studying 218,125 patients. DAPT was associated with significantly lower rates of Cardiovascular mortality (OR 0.71, 95% CI 0.54, 0.93, p=0.01), Major Adverse Cardiovascular And Cerebrovascular Events (MACCE) (OR 0.68, 95% CI 0.61, 0.76, p=0.0001), and Myocardial Infarction (OR 0.78, 95% CI 0.64, 0.94, p=0.009). However, there was no significant association with graft occlusion (OR 0.86, 95% CI 0.68, 1.10, p=0.23), stroke (OR 0.82, 95% CI 0.63, 1.45, p=0.82), All-cause Death (OR 1.06, 95% CI 0.61, 1.84, p=0.84) and major bleeding (OR 1.21, 95% CI 0.81, 1.81, p=0.0001). Conclusion: In conclusion, there were no significant differences in the incidence of graft occlusion, all-cause death, stroke, or serious bleeding between Dual Antiplatelet Therapy (DAPT) and Single Antiplatelet Therapy (SAPT). The p-values exceeded the 5% significance level. However, there were significant differences in the outcomes of cardiovascular mortality, MACCE, and myocardial infarction, with p-values showing statistical significance at a level of less than 5%.