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July 10, 2026Journal of Thrombosis and Thrombolysis

Dual antiplatelet therapy with aspirin and ticagrelor vs aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery: a systematic review and meta-analysis

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Why the study?

The role of dual antiplatelet therapy with ticagrelor plus aspirin after CABG in patients with ACS remains uncertain.

Does ticagrelor plus aspirin reduce ischemic events or increase bleeding compared to aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery?

Population

ACS patients undergoing CABG across five studies from seven articles

Comparison

Ticagrelor plus aspirin vs aspirin alone

Design

Systematic review and meta-analysis of randomized controlled trials and observational studies

Key result

Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding without significant differences in myocardial infarction (OR 0.95; 95% CI 0.53-1.72), stroke, or mortality.

Authors

NANajat Y. AlSejariAGAhmed Farid GadelmawlaAAAmal A. Alsubaiei

Discussion

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Overview

Supports aspirin monotherapy after CABG for ACS to reduce bleeding; challenges routine ticagrelor addition in this setting.

Key Points

  • To evaluate the effectiveness and safety of ticagrelor plus aspirin compared to aspirin alone in ACS patients undergoing CABG.
  • Systematic review and meta-analysis of randomized controlled trials and observational studies
  • Comprehensive search of multiple databases including MEDLINE and Cochrane Library
  • Assessment of outcomes like myocardial infarction, ischemic stroke, all-cause mortality, and major bleeding
  • No significant difference in myocardial infarction (OR: 0.95, 95% CI 0.53–1.72) and other ischemic outcomes.
  • Major bleeding significantly increased with ticagrelor plus aspirin versus aspirin alone.
  • Combined analysis indicated ticagrelor plus aspirin associated with lower risk of major adverse cardiovascular events (OR 0.6, 95% CI 0.43–0.83) based on limited studies.

Study Design

Type

Meta-Analysis

Structured PICO

Does ticagrelor plus aspirin reduce ischemic events or increase bleeding compared to aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery?

P
Population
Meta-analysis of 5 studies comparing ticagrelor plus aspirin versus aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass grafting.
I
Intervention
Ticagrelor plus aspirin
C
Comparator
Aspirin alone
O
Outcome
Myocardial infarction (MI), ischemic stroke, all-cause mortality, bleeding, repeat revascularization, graft occlusion, and major adverse cardiovascular events (MACE)hard clinical

Main Result

Odds Ratio: 0.95 (95% CI 0.53–1.72)

In ACS patients undergoing CABG, adding ticagrelor to aspirin significantly increases major bleeding without consistently reducing ischemic or graft-related outcomes.

Limitations

  • Single studies were key sources of heterogeneity for several outcomes.
  • The MACE estimate was based on only two studies and largely driven by one observational cohort.
  • Single studies as key sources of heterogeneity for several outcomes
  • MACE estimate based on only two studies and largely driven by one observational cohort

Cite This Study

AlSejari et al. (2026) conducted a meta-analysis in Acute coronary syndrome (ACS) undergoing coronary artery bypass graft surgery (CABG). Ticagrelor plus aspirin vs. Aspirin alone was evaluated on Myocardial infarction (MI) (OR 0.95, 95% CI 0.53-1.72). Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding without significant differences in myocardial infarction (OR 0.95; 95% CI 0.53-1.72), stroke, or mortality.

synapsesocial.com/papers/6a5090686eeac72a437a186dhttps://doi.org/10.1007/s11239-026-03354-9
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