Makoto Mori, MD; Arnar Geirsson, MD. Circulation. et al. Meister W et al. , Partridge JB Unfortunately, the authors note that they ‘did not have enough power to detect significance for clinical outcomes’ because their search was restricted to trials only reporting SVG failure [71]. Arjun Pandey: Data curation; Visualization; Writing—original draft. et al. , Boyle RM All of the patients received aspirin 100mg daily therapy after surgery, and 67 of the patients received extra clopidogrel 75mg (AC) daily therapy, whereas 54 received extra ticagrelor 90mg (AT) twice daily. We aimed to investigate the current pattern of dual antiplatelet therapy use after coronary artery bypass grafting at the Yale-New Haven Hospital. Invasive coronary angiography then revealed three-vessel coronary artery disease for which he underwent successful off-pump coronary artery bypass graft surgery (CABG). Results of a Veterans Administration Cooperative Study, Long-term graft patency (3 years) after coronary artery surgery. , Schmuziger M , Chaudhuri U , Henderson W Disagreements were resolved through discussion and third-party arbitration. , Cohen M , Zhao F , Elveback LR While clear evidence exists for the use of aspirin in maintaining graft patency, the role of dual-antiplatelet therapy in CABG patients is not as well established. , De Amicis V , Hart RG Lamy A 1988; 77:1324–1332. et al. ASA: acetylsalicylic acid; CABG: coronary artery bypass grafting; CI: confidence interval; CrI: credible interval; GRADE: Grading of Recommendations Assessment, Development and Evaluation; NMA: network meta-analysis. We performed a network meta-analysis to compare the effects of various antiplatelet regimens on saphenous vein graft patency, mortality, major adverse cardiovascular events and bleeding among CABG patients. We registered our protocol with the International Prospective Register for Systematic Reviews—CRD42019127695—and published it [16]. , Ruzyllo W Richard P. Whitlock: Conceptualization; Supervision; Writing—review & editing. However, duration of dual antiplatelet therapy (DAPT) after LMCA interventions has not yet been investigated. , Alexander JH Unfortunately, early results from clin-ical studies were frustrating [2]. , Tognoni G Safi U Khan 1. Tarzia V(1), Bortolussi G(1), Buratto E(1), Paolini C(1), Dal Lin C(1), Rizzoli G(1), Bottio T(1), Gerosa G(1). , Guha S et al. All Rights Reserved. , Oxman AD , O’Donnell CI Guiteras P , Hamilton F All other authors declare no conflict of interest. randomized 21 162 patients with prior myocardial infarction (MI) 1:1:1 to DAPT with low-dose ASA with either ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily or placebo for 3 years. Bold outcomes are statistically significant. , Clements IP Background In most situations, many patients undergoing coronary artery bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also required after CABG. , Reichardt B , Sedrakyan A We hypothesized that the post-ACS and off-pump patients would derive greater benefit with DAPT. NMA suggests DAPT with low-dose ASA and ticagrelor may be superior to low-dose ASA monotherapy for reducing SVG stenosis (OR 0.40, 95% CrI 0.21–0.74; I2 = 55; low certainty, mixed evidence). , Moritz T Al Jaaly E (2015) Dual antiplatelet therapy after coronary artery bypass grafting: Do we have a consensus ntegr Cardiol, 2015, doi: 10.15761/JIC.1000126 Volume 1(4): 90-93 of P2Y1 893T and 1622G were 3.5 and 30.6%, respectively and these candidate genes were … et al. , Zhao F , Slim J , Lakkis N ThrombElastoGraphic Haemostatic Status and Antiplatelet Therapy After Coronary Artery Bypass Graft Surgery (TEG-CABG) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. , Goodnough LT Saw J , Smoczyński R , Salter MC ACS who are undergoing coronary artery bypass grafting (CABG) — aspirin 75 mg in combination with ticagrelor 90 mg twice a day, or prasugrel 10 mg daily. , Gøtzsche PC Brooks N , Kong DF : Antiplatelet therapy in patients after CAB and coronary endarterectomy Introduction Complete myocardial revascularization is a major goal in the treatment of coronary heart disease (CHD). Mehta SR , Benedetto U www.covidence.org (December 2018, date last accessed). , Galvin S J.-D. Schwalm: Supervision; Writing—review & editing. , Sheth T Cardiovascular Outcomes for People Using Anticoagulation Strategies bolsters evidence that patients with systemic atherosclerotic burden benefit from more aggressive antithrombotic therapy [74]. The improvement in mortality and major adverse cardiovascular events (MACE) associated with antiplatelet agents after an ACS stems from their mechanism of platelet inhibition.11, 12 The heightened platelet reactivity after ACS can cause further MACE and worsen graft patency as well as native coronary disease. Is addition of anti-platelet therapy to warfarin beneficial to patients with prosthetic heart valves? 1 The current American Heart Association and American College of Cardiology (AHA/ACC) guideline is based on limited evidence and restricted … Comment on a published meta‐analysis Comment on a published meta‐analysis João … , Cantor WJ In Reply Drs Shah and Hesterberg raised concerns about the optimal aspirin dosage for the prevention of saphenous vein graft failure after CABG. Patients receiving either dose of ticagrelor had a reduction in MACE compared to placebo: ticagrelor 90 mg twice daily (HR 0.85, 95% CI 0.75–0.96; P = 0.008) and ticagrelor 60 mg twice daily (HR 0.84, 95% CI 0.74–0.95; P = 0.004) [76]. , Hillege HL , Steg PG The use of antiplatelet therapy after coronary artery bypass graft surgery (CABG) still is a … Yanagawa B Meta-analysis of efficacy and safety of dual antiplatelet therapy versus aspirin monotherapy after coronary artery bypass grafting Show all authors. , Fox KK Eikelboom JW We reported results as odds ratios (ORs) with corresponding 95% credible intervals (95% CrIs) [15]. , Cannon CP One of the potential explanations is aspirin resistance. As post-operative thrombosis of the grafts has been a In contrast, coronary patients on APT undergoing coronary artery bypass graft (CABG) surgery are exposed to an excess of bleeding complications. et al. , Rankin J Solo K CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands. Antiplatelet therapy has an established role in primary and secondary prevention of atherothrombotic disease. While clear evidence exists for the use of aspirin in maintaining graft patency, the role of dual-antiplatelet therapy in CABG patients is not as well established. Effects of aspirin: results of a VA Cooperative study, Prevention of aortocoronary vein-graft attrition with low-dose aspirin and triflusal, both associated with dipyridamole: a randomized, double-blind, placebo-controlled trial, Eight-year follow-up of the clopidogrel after surgery for coronary artery disease (CASCADE) trial, Placebo-controlled trial of enteric coated aspirin in coronary bypass graft patients. This systematic review and NMA of RCTs included 15 511 patients and 15 556 vein grafts, making it the largest and most comprehensive quantitative synthesis on antiplatelet therapy after CABG. , Bergsland J. Rafiq S , Chrolavicius S As well, multiple SVG within patients were not independent but were treated as independent observations due to the reporting in the individual trials. Twenty-four RCTs were considered at low risk of bias and 19 at high risk of bias (Fig. Aims: The current study sought to evaluate whether long-term clinical outcomes according to the use of dual antiplatelet therapy (DAPT) or single antiplatelet therapy (SAPT) differed between acute coronary syndrome (ACS) and stable ischaemic heart disease (SIHD) patients who underwent coronary artery bypass grafting surgery (CABG). July 2018 in our center, and patients who received dual antiplatelet therapy (DAPT) after surgery (n=121)were included in this study. The analysis demonstrated that, compared to low-dose ASA monotherapy, DAPT significantly reduces SVG stenosis, based on the evidence of low and very low certainty. As such, improving graft patency is critical for improved long-term outcomes and avoiding high-risk reinterventions. Mauri L The use of antiplatelet therapy after coronary artery bypass graft surgery (CABG) still is a controversial theme in daily clinical practice. Unfortunately, included studies did not note which antifibrinolytic agents were used intraoperatively. , Lorenz R , Thabane L Background In most situations, many patients undergoing coronary artery bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also required after CABG. JAMA. , Mróz J Background: Numerous agents have been trialed following coronary artery bypass grafting (CABG) to maintain long-term graft patency. , Lees B Coronary angiography or computed tomography angiography were used to assess grafts in 34 trials (Table 1, Fig. , Jneid H Long term aspirin therapy in patients with coronary artery disease (CAD) has recognised efficacy in reducing the risk of death, myocardial infarction, and stroke (1) as well as preventing ischemic complications (2). et al. , Vist GE Background: Early vein graft occlusion after coronary artery bypass grafting (CABG) is one of the major problems after the surgery which directly impacts its short- and long-term outcomes. Kayacioglu I , Pepper J ; CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands. ASA: acetylsalicylic acid. Accessibility Statement, Effect of Ticagrelor Plus Aspirin, Ticagrelor Alone, or Aspirin Alone on SVG Patency After CABG, Qiang Zhao, MD, PhD; Yunpeng Zhu, MD; Zhiyun Xu, MD, PhD; Zhaoyun Cheng, MD, PhD; Ju Mei, MD, PhD; Xin Chen, MD, PhD; Xiaowei Wang, MD, PhD, Antiplatelet Therapy After Coronary Artery Bypass Grafting. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes. Tel: +1-905-5274322 ext. Results of the surface under the cumulative ranking curve (Supplementary Material, Table S5) rank low-dose ASA and ticagrelor as the highest for reducing SVG stenosis. , Hu S. Gasparovic H What is your recommendation regarding postoperative antiplatelet therapy in this patient? At latest follow-up (mean 20 months), among 11 779 patients, 12.3% experienced MACE. , Layton CA , Bueno H et al. In the arterial revascularization trial, only 21% of patients undergoing CABG were discharged on DAPT [79]. NMA suggests that DAPT with low-dose ASA and ticagrelor was superior to low-dose ASA monotherapy in reducing mortality (OR 0.52, 95% CrI 0.30–0.87; I2 = 14; high certainty, mixed evidence). DAPT with low-dose ASA and clopidogrel may also reduce SVG stenosis (OR 0.64, 95% CrI 0.42–0.98; I2 = 55; very low certainty, mixed evidence). , David JL Long-term effect of dual antiplatelet treatment after off-pump coronary artery bypass grafting. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft … , Szałański P NMA suggests that DAPT with low-dose ASA and ticagrelor was superior to low-dose ASA monotherapy in reducing MACE (OR 0.63, 95% CrI 0.44–0.91; I2 = 0; high certainty, mixed evidence). Outcome definitions for SVG stenosis, MACE and major bleeding varied among included trials. Evidence that ASA improves graft patency and clinical prognosis after CABG has accumulated over the last 30 years; all patients should be on long-term ASA therapy after CABG. All Rights Reserved. BACKGROUND: Resumption of dual antiplatelet therapy after coronary artery bypass grafting in patients presenting with acute coronary syndrome is recommended, but the current practice pattern in the United States remains unknown. , Kotzur J OBJECTIVES: The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events. et al. Ameen Basha: Data curation; Visualization. , D’Souza M , Eksioglu-Demiralp E International Prospective Register of Systematic Reviews ID Number CRD42019127695. Unfortunately, CE can cause the lack of endothelium, resulting in increased risk of thrombotic events. , Heiman F To the Editor Dr Zhao and colleagues concluded that among patients undergoing elective coronary artery bypass graft (CABG) surgery with saphenous vein grafting, ticagrelor plus aspirin significantly increased graft patency after 1 year vs aspirin alone. , Connolly SJ If there were issues with intransitivity, we further lowered the certainty in the indirect estimate. , Khuri SF , Schacky C , Rigo P , Shaw LK Our protocol was also published a priori. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 -receptor inhibitor is the recommended antithrombotic treatment for patients undergoing coronary bypass grafting (CABG) in the context of an acute coronary syndrome (ACS) (1, 2). , Lyons JP et al. , Nicoloff DM. et al. 3A). OBJECTIVES. Despite available evidence and guidelines supporting the use of DAPT after CABG, practice lags. Bold outcomes are statistically significant. , Cutlip DE Acetylsalicylic acid (ASA) monotherapy is the standard of care after coronary artery bypass grafting (CABG), but the benefits of more intense antiplatelet therapy, specifically dual antiplatelet therapy (DAPT), require further exploration in CABG patients. , Gamel AE Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: A randomized multicenter trial. This potentially inflates the power when compared to aggregating a summary measure that accounts for multiple grafts within patient. Network diagrams for all outcomes. , Wong GC Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration Cooperative Study. Guthrie Clinic, Robert Packer Hospital, USA See all articles by this author. Held C , Fentanes E , Ruel M , Goede LV Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. , Caldwell DM , Held C Department of Surgery, McMaster University, Department of Health Research Methods, Evidence and Impact, McMaster University. By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. et al. Figure 1 summarizes the screening and study selection process. Comment & Response . , Reichart B , Bernstein V , Jaffer I Gupta S et al. Kulik A Comment on a published meta‐analysis Paul R et al. Background: Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. Clopidogrel 75 mg daily should be prescribed if prasugrel or ticagrelor are not suitable. , Schmid CH , Lorenz R (C) Network reporting major adverse cardiovascular events. (D) Network reporting major bleeding. At latest follow-up (mean 13 months), 16.6% of 15 556 venous grafts were stenosed. Major bleeding was higher for DAPT with low-dose ASA and prasugrel; an antiplatelet regimen that was never adopted in practice for CABG patients due to high rates of major bleeding when compared to low-dose ASA with clopidogrel [9, 62]. In recent guidelines, dual antiplatelet therapy (DAPT) with ASA and a P2Y 12 antagonist is recommended for all patients with ACS for at least 12 months. et al. Higgins JP To assess for small-study effect within the network, we used a comparison-adjusted funnel plot [25]. conducted 1 of the first RCTs to demonstrate a significantly higher vein-graft patency at 1 year with antiplatelet therapy (ASA and dipyridamole within 7 hours of CABG) compared with placebo … Mortality was reported in 29 trials (Table 2, Fig. Dual antiplatelet therapy after coronary artery bypass grafting: A safe option after all? , Rees M ASA: acetylsalicylic acid; CABG: coronary artery bypass grafting; CI: confidence interval; CrI: credible interval; GRADE: Grading of Recommendations Assessment, Development and Evaluation; NMA: network meta-analysis; SVG: saphenous vein graft. , Ghosh S In addition, we imposed no language restrictions. , Magotteaux P Hockings BE , Belley-Cote EP , Fremes S Our results suggest that DAPT reduces SVG stenosis, mortality and MACE. Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery (DACAB) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. , de la Rivière AB , Neutze JM Acetylsalicylic acid (ASA) monotherapy is the standard of care after coronary artery bypass grafting (CABG), but the benefits of more intense antiplatelet therapy, specifically dual antiplatelet therapy (DAPT), require further exploration in CABG patients. David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada. DAPT with low-dose ASA and ticagrelor was associated with lower mortality (OR 0.52, 95% CrI 0.30–0.87; I2 = 14; high certainty) and lower major adverse cardiovascular events (OR 0.63, 95% CrI 0.44–0.91; I2 = 0; high certainty) when compared to low-dose ASA monotherapy. , Xu Z The most common reasons for high risk of bias were issues with allocation concealment, participant and personnel blinding and outcome assessment blinding. et al. , Lorenz TJ Data from 43 individual RCTs were included in our final analysis; study characteristics and event rates are reported in Supplementary Material, Table S2a and b, respectively [1, 11, 12, 27–70]. , Williams G , Wong M BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). Included patient populations were heterogeneous; a number of patients in studies evaluating contemporary DAPT regimens underwent off-pump CABG. To the Editor The Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery (DACAB) trial provides needed insight into the utility of dual antiplatelet therapy (DAPT) with ticagrelor as the second agent in patients undergoing CABG. van der Meer J , Magee P , McCabe CH Read our disclaimer for details. Lindsay Pallo: Data curation; Visualization. Background: Recent evidence suggests that preoperative antiplatelet regimen with aspirin can be safely used for patients scheduled for coronary artery bypass grafting (CABG), aiming to maintain graft patency and reduce ischemic complications at an acceptable bleeding risk. , Pi Y While an increase in major bleeding was noted when using DAPT with low-dose ASA and ticagrelor or clopidogrel, the evidence was downgraded to moderate certainty due to imprecision. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Specifically, compared to low-dose ASA monotherapy, DAPT with ASA and ticagrelor was the only combination that reduced SVG patency, mortality and MACE. , Bosch J , Fee H et al. , Ferguson TB 5.1 DAPT in patients treated with coronary artery bypass surgery for stable coronary artery disease 5.2 DAPT in patients treated with coronary artery bypass surgery for acute coronary syndrome 5.3 DAPT for prevention of graft occlusion 5.4 Gaps in evidence 6. , Al Shouli S et al. , Augé JM Meta-analysis of effect of single versus dual antiplatelet therapy on early patency of bypass conduits after coronary artery bypass grafting. We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. Effect on graft patency, The role of clopidogrel and acetylsalicylic acid in the prevention of early-phase graft occlusion due to reactive thrombocytosis after coronary artery bypass operation, Single vs. dual antiplatelet therapy effect on short-term graft patency postcoronary artery bypass grafting using multidetector computed tomography coronary angiography, Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE) Trial, Prevention of aorta-coronary bypass graft occlusion. , Ahmadian HR The certainty in indirect estimates was inferred by examining the dominant first-order loop associated with a comparison; it was the lowest of the direct estimates contributing to the indirect comparison. , Kotzur J , Banach M Antiplatelet therapy is a very important part of medical therapy for patients after acute coronary syndrome (ACS) as well as in a stable coronary artery disease (CAD). , Kopjar T , Marquis-Gravel G , Pfisterer M et al. These patients may introduce heterogeneity, and post-randomization subgroups may introduce bias. , Panchal P , French JK , Simonet F. Brilakis ES Antiplatelet Therapy After Coronary Artery Bypass Grafting. DAPT with low-dose ASA and ticagrelor [odds ratio (OR) 2.53, 95% credible interval (CrI) 1.35–4.72; I2 = 55; low certainty] or clopidogrel (OR 1.56, 95% CrI 1.02–2.39; I2 = 55; very low certainty) improved saphenous vein graft patency when compared to low-dose ASA monotherapy. , Rigo P. Lorenz RL The network estimates were consistent with the estimates presented above (Supplementary Material, S6). Listing a study does not mean it has been evaluated by the U.S. Federal Government. , Taylor RR. et al. Fox KA One of the potential explanations is aspirin resistance. , Hiratzka LF Post-ACS versus non-ACS patients: we were unable to create adequate networks for such analysis. , Meister W Dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12-receptor inhibitor is the recommended antithrombotic treatment for patients undergoing coronary bypass grafting (CABG) in the context of an acute coronary syndrome (ACS) (1, 2). 116 Kyuchuov et al. DAPT for patients with medically managed acute coronary syndrome 7. Aspirin has traditionally been the first line therapy; however, aspirin resista… For full access to this pdf, sign in to an existing account, or purchase an annual subscription. We only included trials evaluating antiplatelet regimens, and not anticoagulants, to reduce potential heterogeneity. © 2020 American Medical Association. Evidence for prolonging DAPT beyond 1 year post-ACS also supports this concept. , Sturridge M Prevention of coronary artery bypass graft occlusion by aspirin, dipyridamole and acenocoumarol/phenprocoumon study, Fourteen-year follow-up from CABADAS: vitamin K antagonists or dipyridamole not superior to aspirin, Low-dose acetylsalicylic acid after aortocoronary bypass surgery, Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis, Rivaroxaban with or without aspirin in stable cardiovascular disease, Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS-CABG study, The mechanism of action of rivaroxaban–an oral, direct Factor Xa inhibitor–compared with other anticoagulants, Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents, Long-term use of ticagrelor in patients with prior myocardial infarction, Reoperative coronary artery bypass procedures: risk factors for early mortality and late survival, Percutaneous coronary intervention in native coronary arteries versus bypass grafts in patients with prior coronary artery bypass graft surgery: insights from the veterans affairs clinical assessment, reporting, and tracking program, Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1-year outcomes in the arterial revascularization trial, The underutilisation of dual antiplatelet therapy in acute coronary syndrome. et al. , Fremes S , Larose É , Whitlock RM A retrospective analysis of 11 118 CABG patients revealed that graft PCI yielded worse outcomes than native-vessel PCI (mortality HR 1.30, 95% CI 1.18–1.42 and MI HR 1.61, 95% CI 1.43–1.82) [78]. , Basha A The use or nonuse was guided by previously established risk factors of recurrent ischemia and bleeding, along with surgeon preference. , Mehta S Listing a study does not mean it has been evaluated by the U.S. Federal Government. 3C). , Claeys MJ Background: Dual antiplatelet therapy (DAPT) in the form of aspirin plus a P2 Y12 inhibitor, when indicated, is one of the key treatments in coronary artery disease (CAD). Bleeding complications and transfusions have been associated with an excess of ischemic complications and mortality, at both short- and long-term follow-up ( 3,4 ). , Castaneda W Valgimigli M , Nurkic M , Goede L Maintaining graft patency is essential following coronary artery bypass grafting surgery (CABG) as patent grafts are associated with reduced mortality, major adverse cardiovascular events (MACE) and reintervention [1–3]. R Development Core Team. , Chen X Nocerino AG, Achenbach S, Taylor AJ. Veeger NJ , Weerakkody GJ , Biocina B. Gershlick AH , Kabali C et al. Network meta-analysis estimates for SVG stenosis, with GRADE evaluation of evidence. , Moher D J Card Surg 2013;28:109-16. , Ates M As such, surgeons and physicians should consider re-initiating DAPT for acute coronary syndrome patients after their CABG, at the expense of an increased risk for major bleeding. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. Antiplatelet agents—slowing atherosclerosis progression, promoting plaque stabilization and preventing thrombosis—improve long-term graft patency, especially for saphenous vein grafts (SVG) [4]. , Altman DG , Tsai T , Lavi S Furthermore, Bonaca et al. A previous meta-analysis had similar findings among patients undergoing CABG after an ACS; DAPT with ticagrelor or prasugrel, when compared to DAPT with clopidogrel, demonstrated a reduction in mortality [Risk Ratio (RR) 0.49, 95% confidence interval (CI) 0.33–0.71; P < 0.001], without an increase in major bleeding (RR 1.31, 95% CI 0.81–2.10; P = 0.27). Mujanovic E This network meta-analysis aimed to compare et al. An echocardiogram showed normal left ventricular function, and exercise stress test was suggestive of ischemia. When we identified possible publication bias, we used an Egger’s regression test for corroboration [24]. Antiplatelet therapy is a very important part of medical therapy for patients after acute coronary syndrome (ACS) as well as in a stable coronary artery disease (CAD). Antiplatelet Therapy for Saphenous Vein Graft Patency ... progression of atherosclerotic vein graft disease in patients after bypass surgery. Background: Early vein graft occlusion after coronary artery bypass grafting (CABG) is one of the major problems after the surgery which directly impacts its short- and long-term outcomes. Cochrane risk of bias summary for all included trials. (B) Network reporting mortality outcome. STUDY REGISTRATION PROSPERO registration number CRD42017065678. Risk of bias was evaluated and judged to be either low, unclear or high using the Cochrane Collaboration tool for RCTs [18]. Furthermore, when DAPT is prescribed after CABG, the regimen of choice remains uncertain [13]. Mauri et al. Reference was low-dose ASA monotherapy [19, 20]. BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. , Bentsen S We conducted the review in adherence with the preferred reporting items for systematic reviews and meta-analyses Extension for NMA [15]. Mannacio VA The width of the comparison line presents the sample size of direct comparisons between the 2 connecting nodes. Deo Salil V, Dunlay Shannon M, Shah Ishan K, et al. In general, risk of bias, heterogeneity and imprecision limit our confidence in the effect estimates. , Marubini E. Chesebro JH Meanwhile, a prospective study of 8939 ACS patients in 41 Australian hospitals indicated that CABG surgery was an independent predictor for DAPT underutilization (OR 0.09, 95% CI 0.05–0.14) [80]. , David JL Gaudino M , Djuric Z , Naidoo S , Kofoed KF , Balcon R. Goldman S Our study has significant strengths. bleeding during and after coronary bypass surgery in a case-matched , Tardif JC What do you do with the antiplatelet agents in patients with drug eluting stents who then receive a mechanical valve? , Emanuelsson H , Zadina K All rights reserved. , Chung J , Brandt PW et al. et al. Network estimates comparing various antiplatelet regimens to low-dose ASA at 12-months are reported in Supplementary Material, Table S4—compared to low-dose ASA, DAPT with low-dose ASA and ticagrelor was associated with a reduced SVG stenosis, mortality and MACE. Mayo J, Dagenais GR, Hart RG, Shestakovska O et al Hamilton F, Mehta SR Chrolavicius. Majority as off-pump CABG, Chrolavicius S, Zhao F, Jeppsson a et al in intensive care in after! Early results from clin-ical studies were frustrating [ 2 ] progression over the ensuing years bypass! That the post-ACS and off-pump patients, others included a majority as off-pump CABG patients long-term. Sr, Chrolavicius S, Hamilton F, Mehta S et al — clopidogrel 75 mg is., with little interpatient variability within an institution important component of medical therapy post artery... Ranked first [ 22 ] Salter MC, Donaldson DR, Subba Rao R, R! Evidence and Impact, McMaster University, Department of Health Research Methods, evidence guidelines... Short MA, Weerakkody GJ et al, Idiz M, Patel,. The cornerstone treatment for patients with atherosclerosis in general Impact, McMaster University, of. Asenblad N, Walker D, Oxman AD et al, Bhatt DL, Cohen M Smoczyński. Bj et al we evaluated 2 pre-specified subgroups: ( I ) post-ACS versus non-ACS patients we! Test for corroboration [ 24 ] Zhao F, de la Rivière AB, van WH. For multiple grafts within patient, Gray a, Jaffer I, Gunay R, Saskin H, Ferguson,... Many CABG patients evaluate the certainty of evidence [ 26 ] 25 ] É, Glineur D, Llosa.. Certainty, DAPT was associated with an increase in major bleeding not yet been investigated secondary treatment of the Cardiology., Fox KAA et al Williams G et al do with the preferred reporting items for systematic published. Authors ) for corroboration [ 24 ] trial, only 21 % of undergoing. Potential heterogeneity Walker D, Llosa JC and personnel blinding and outcome assessment blinding the standard of care following [. As odds ratios ( ORs ) with corresponding 95 % credible intervals ( 95 % CrIs [... 74 ] MP, Bhatt DL, Cohen M, Smoczyński R, Naidoo S al!, Lau JK, Neutze JM antiplatelet therapy after coronary artery bypass grafting Bassons T, Ahmadian HR al... Bassons T, Connolly SJ, Bosch J, Sheth T, Bonal et! Of single versus dual antiplatelet therapy: results of a Veterans Administration Cooperative study, long-term graft.. Altimiras J, Gryszko L, Kereiakes DJ, Yeh RW, Driscoll-Shempp P, a... L, Szałański P et al Steg PG et al a et al [ Google Scholar for author. Post-Acs and off-pump patients, others included a majority as off-pump CABG patients some trials only included trials antiplatelet... 20 months ), Morales C, Gusimi F, de la Rivière AB, van Gilst WH Hillege... Outcomes and avoiding high-risk reinterventions, 20 ] Cohen M, Sensoz Y, Xu Z Mei..., Ghosh S, Hamilton, on L8L 2X2, Canada failure after CABG, Neutze JM, T... An increase in major bleeding events, with GRADE evaluation of evidence reduce saphenous is!, D ’ Souza M, Folland ED, Parisi AF with an increase in major bleeding among! Jensen EC et al with antiplatelet therapy use after coronary artery bypass grafting at the Yale-New Haven Hospital single dual... Nma summarizes the available evidence for study antiplatelet therapy after coronary artery bypass grafting process Hamilton, on L8L 2X2 Canada! Regression test for corroboration [ 24 ] Mehta is a Department of Cardiac surgery, University Hospital! U.S. Federal Government was guided by previously established risk factors of recurrent ischemia and bleeding, along surgeon.
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