DAPT After CABG Better Than Aspirin Alone for Preventing Saphenous Graft Failure

By Amy Orciari Herman

Edited by William E. Chavey, MD, MS

In patients undergoing coronary artery bypass grafting (CABG), dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel is superior to aspirin alone for preventing saphenous vein graft failure, according to a meta-analysis in The BMJ.

The analysis comprised 20 randomized trials that compared post-CABG oral antithrombotic regimens with each other or with placebo. Some 4800 adults who received saphenous grafts were included; follow-up ranged from 1 month to 8 years.

Compared with aspirin monotherapy, DAPT with aspirin plus ticagrelor was associated with reduced risk for venous graft failure (odds ratio, 0.5), as was aspirin plus clopidogrel (OR, 0.6). The researchers calculated that 10 patients would need to receive aspirin plus ticagrelor or 19 would need to receive aspirin plus clopidogrel to prevent one graft failure.

Risk for major bleeding did not differ significantly across the active drug interventions.

Dr. Harlan Krumholz of NEJM Journal Watch Cardiology comments, "There are lots of caveats in this study, such as the focus on saphenous vein failure rather than clinical events and studies over a 39-year period, but such is the state of the evidence. For now, DAPT seems generally favored, though each patient's individual situation should be considered."