Key result
Dual antiplatelet therapy with ticagrelor and aspirin showed no significant difference in overall major bleeding compared to clopidogrel, but significantly reduced all-cause mortality when administered post-CABG (OR 0.49) and minimized major bleeding when discontinued more than 3 days before surgery (OR 0.62).
Why the study?
The study was conducted to evaluate the efficacy and safety of DAPT with aspirin combined with ticagrelor, clopidogrel, or prasugrel in CABG patients.
Does dual antiplatelet therapy with aspirin and ticagrelor, clopidogrel, or prasugrel improve efficacy and safety outcomes in CABG patients?
Meta-Analysis (n=9,585)
Does dual antiplatelet therapy with aspirin and ticagrelor, clopidogrel, or prasugrel improve efficacy and safety outcomes in CABG patients?
Odds Ratio: 1.01 (95% CI 0.78–1.31)
p-value: p=0.92
In CABG patients, DAPT with aspirin and ticagrelor reduces all-cause mortality and offers the best balance of efficacy and safety compared to other P2Y12 inhibitors.
Ticagrelor-based DAPT reduces post-CABG mortality without excess bleeding; extends evidence for optimal perioperative discontinuation timing.
Introduction This meta-analysis evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin combined with ticagrelor, clopidogrel, or prasugrel in coronary artery bypass grafting (CABG) patients. Material and Methods Nineteen studies involving 9,585 patients were included. Results Post-CABG administration of ticagrelor significantly reduced all-cause mortality (OR = 0.49 [0.33, 0.73]; p < 0.01) and minimized major bleeding when discontinued more than 3 days before surgery (OR = 0.62 [0.47, 0.83]; p < 0.01). Ticagrelor exhibited a non-significant trend toward reducing both re-bleeding and the need for platelet transfusions. Prasugrel was associated with a higher requirement for platelet transfusions (OR = 1.88; 95% CI: 1.24-2.87; p < 0.01). No significant associations were found for myocardial infarction, stroke, or RBC transfusion. Conclusions In CABG patients, DAPT with aspirin and ticagrelor offers the best balance between efficacy and safety, improving key outcomes while managing bleeding risk. Prasugrel’s increased bleeding risk requires caution in its use.
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Salman et al. (2025) conducted a meta-analysis in Coronary artery disease undergoing CABG (n=9,585). Ticagrelor plus aspirin vs. Clopidogrel plus aspirin was evaluated on Major bleeding (OR 1.01, 95% CI 0.78-1.31, p=0.92). Dual antiplatelet therapy with ticagrelor and aspirin showed no significant difference in overall major bleeding compared to clopidogrel, but significantly reduced all-cause mortality when administered post-CABG (OR 0.49) and minimized major bleeding when discontinued more than 3 days before surgery (OR 0.62).
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