Key result
DAPT reduces graft failure post-CABG versus aspirin alone but increases clinically important bleeding.
Why the study?
Thrombosis is the predominant mechanism of early CABG graft failure, requiring a balance between thrombotic and bleeding risks when selecting post-CABG antithrombotic therapy.
Does antithrombotic therapy prevent graft thrombosis in patients undergoing coronary artery bypass grafting?
Does antithrombotic therapy prevent graft thrombosis in patients undergoing coronary artery bypass grafting?
Dual antiplatelet therapy reduces early graft thrombosis after CABG compared to aspirin alone but increases bleeding risk, highlighting the need for individualized antithrombotic strategies.
Requires weighing graft benefits vs bleeding with DAPT post-CABG; leaves open optimal regimens via RCTs.
Coronary artery bypass grafting (CABG) is the most frequently performed cardiac surgery worldwide. The reported incidence of graft failure ranges between 10% and 50%, depending upon the type of conduit used. Thrombosis is the predominant mechanism of early graft failure, occurring in both arterial and vein grafts. Significant advances have been made in the field of antithrombotic therapy since the introduction of aspirin, which is regarded as the cornerstone of antithrombotic therapy for prevention of graft thrombosis. Convincing evidence now exists that dual antiplatelet therapy (DAPT), consisting of aspirin and a potent oral P2Y 12 inhibitor, effectively reduces the incidence of graft failure. However, this is achieved at the expense of an increase in clinically important bleeding, underscoring the importance of balancing thrombotic risk and bleeding risk when considering antithrombotic therapy after CABG. In contrast, anticoagulant therapy has proved ineffective at reducing the occurrence of graft thrombosis, pointing to platelet aggregation as the key driver of graft thrombosis. We provide a comprehensive review of current practice for prevention of graft thrombosis and discuss potential future concepts for antithrombotic therapy including P2Y 12 inhibitor monotherapy and short-term DAPT.
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Harik et al. (2023) conducted a review in Coronary artery disease requiring CABG. Antithrombotic therapy (Aspirin, DAPT, P2Y12 inhibitor monotherapy) was evaluated. Dual antiplatelet therapy effectively reduces the incidence of graft failure after coronary artery bypass grafting compared to aspirin alone, but increases the risk of clinically important bleeding.
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