CoCAPCardiac SurgeryOpen Access
Dual Antiplatelet Therapy Versus Aspirin Alone for Graft Patency After Bypass Surgery
Graft patency in patients with acute coronary syndrome treated with dual antiplatelet therapy or aspirin alone after coronary artery bypass grafting
Why the trial?
Dual antiplatelet therapy is often continued after CABG for acute coronary syndrome, but whether it actually improves graft patency compared with aspirin alone — at the cost of more bleeding — lacked solid randomised evidence.
Does ticagrelor plus aspirin improve graft patency compared to aspirin alone in patients with acute coronary syndrome after coronary artery bypass grafting?
Population
Patients with ACS after CABG in the TACSI trial; substudy N not reported
Comparison
Ticagrelor plus aspirin (DAPT) vs aspirin alone
Design
Coronary CT angiography substudy of the randomized TACSI trial
Follow-up
Mean 20 months after surgery
Key result
Dual antiplatelet therapy with ticagrelor plus aspirin did not improve graft patency compared with aspirin alone at a mean of 20 months after coronary artery bypass grafting.
Authors
Discussion
Member takes
Overview
Supports aspirin monotherapy post-CABG in ACS; challenges routine ticagrelor addition for graft patency.
Key Points
- To determine whether dual antiplatelet therapy with ticagrelor and aspirin improves coronary bypass graft patency compared to aspirin alone in patients with acute coronary syndrome.
- Substudy (CoCAP) of the TACSI trial evaluating patients with acute coronary syndrome after coronary artery bypass grafting.
- Patients received either ticagrelor plus aspirin (dual antiplatelet therapy) or aspirin alone.
- Graft patency was assessed via coronary CT angiography at a mean follow-up of 20 months after surgery.
- Dual antiplatelet therapy did not improve graft patency compared with aspirin monotherapy at a mean follow-up of 20 months post-surgery.
Evidence details
Limitations & tradeoffs
Statistical certainty
No numeric graft patency rates, sample size, or effect estimates are reported in the record.
Design limitations
Graft patency is a surrogate endpoint; the substudy record reports no clinical outcomes or bleeding data.
Structured PICO
Does ticagrelor plus aspirin improve graft patency compared to aspirin alone in patients with acute coronary syndrome after coronary artery bypass grafting?
P
Population
Patients with acute coronary syndrome after coronary artery bypass grafting, followed for a mean of 20 months.
I
Intervention
Ticagrelor plus aspirin (dual antiplatelet therapy)
C
Comparator
Aspirin alone
O
Outcome
Graft patency assessed using coronary CT angiographysurrogate
In patients with acute coronary syndrome undergoing coronary artery bypass grafting, adding ticagrelor to aspirin did not improve graft patency at 20 months compared to aspirin alone.
Cite This Study
Jonas Holm (2026) conducted an RCT in Acute coronary syndrome after coronary artery bypass grafting. Ticagrelor plus aspirin vs. Aspirin alone was evaluated on Graft patency assessed using coronary CT angiography. Dual antiplatelet therapy with ticagrelor plus aspirin did not improve graft patency compared with aspirin alone at a mean of 20 months after coronary artery bypass grafting.