Secondary prevention for CABG patients: take two arterial grafts at the time of your coronary operation

Due to its platelets-inhibitory effect, aspirin is one of the cornerstones in the field of prevention of ischemic events, having been widely shown to improve survival in patients with ischemic heart disease (1-4). The main reason explaining the antiplatelet activity of this drug consists in its ability to irreversibly act on thromboxane-A2 (TXA2), by reducing its production. As part of the wide spectrum of patients with ischemic heart disease, aspirin plays a key role also in the cohort of those undergoing coronary artery bypass grafting (CABG) surgery. Vein graft patency has in fact been demonstrated to be strongly influenced by aspirin, with angiographically detected vein graft occlusion occurring up to five times more frequently in patients receiving placebo than in those receiving acetylsalicylic acid (5). Aspirin administration shortly after CABG has been proved to improve survival by reducing the burden of ischemic events (6) and, accordingly, international guidelines recommend aspirin to be initiated within 6–12 hours postoperatively, if not administered preoperatively (7,8).