Dual versus single antiplatelet therapy after coronary artery bypass grafting: a meta-analysis of randomized controlled trials

Objectives The optimal antiplatelet strategy after coronary artery bypass grafting (CABG) remains uncertain. We conducted a meta-analysis of randomized trials comparing dual versus single antiplatelet therapy (DAPT versus SAPT), focusing on graft patency and clinical outcomes. Methods A systematic literature review was performed through January 2026. Randomized controlled trials (RCT) comparing DAPT with SAPT after CABG were included. The primary outcomes were patency assessed per graft and per patient. Secondary outcomes included major adverse cardiac and cerebrovascular events (MACCE), all-cause mortality, myocardial infarction (MI), stroke, and major bleeding. Pooled analyses were performed using a random-effects model. Results Fourteen trials involving 9,158 patients (DAPT: n=4,556; SAPT: n=4,602) were analyzed. DAPT significantly improved patency per graft (risk ratio [RR], 1.04; 95% CI, 1.00-1.08; p = 0.042), but not per patient (RR, 1.05; 95% CI, 0.96-1.14; p = 0.262). There was a non-significant reduction in MACCE (RR, 0.86; 95% CI, 0.72-1.02; p = 0.072). No significant differences were observed in all-cause mortality (RR, 0.95; 95% CI, 0.43-2.11; p = 0.89) or MI (RR, 0.82; 95% CI, 0.52-1.30; p = 0.347). Stroke was significantly reduced (RR, 0.61; 95% CI, 0.40-0.94; p = 0.03). Major bleeding did not differ significantly (RR, 1.26; 95% CI, 0.84-1.90; p = 0.232). Conclusions DAPT improved graft-level patency and reduced stroke without increasing major bleeding compared with SAPT, but did not improve survival. The potential benefit of DAPT after CABG remains uncertain and the strategy of DAPT versus SAPT should be individualized based on the ischemic and bleeding risk factors.