Physicians' Academy for Cardiovascular Education

DAPT vs. aspirin after CABG: less vein graft failures, more bleeding

Association of Dual Antiplatelet Therapy With Ticagrelor With Vein Graft Failure After Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-analysis

Literature - Sandner S, Redfors B, Angiolillo DJ, et al. - JAMA. 2022 Aug 9;328(6):554-562. doi: 10.1001/jama.2022.11966

Introduction and methods


Of alle saphenous vein grafts placed, 10%–25% occlude within the first year after surgery [1,2], mainly due to thrombosis [2,3]. Although dual antiplatelet therapy (DAPT ) is the guideline-recommended therapy after percutaneous coronary revascularization [4], there is considerable controversy regarding the benefit of DAPT after CABG surgery.

Aim of the study

The authors aimed to compare the effects of ticagrelor DAPT with aspirin alone on saphenous vein graft failure and bleeding events after CABG surgery.


In this systematic review and meta-analysis, 4 RCTs comparing the effects of ticagrelor DAPT or ticagrelor monotherapy versus aspirin on failure of saphenous vein grafts (n=1668 in total) in 1316 patients undergoing CABG surgery who had follow-up for graft imaging were selected from the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases. Individual patient data were collected from the principal investigators of the eligible trials.


In the primary analysis, the incidence of saphenous vein graft failure per graft—defined as saphenous vein graft occlusion or stenosis >50%—was the primary outcome. Secondary outcomes were the incidences of saphenous vein graft failure per patient, Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events, composite outcome of saphenous vein graft failure or CV death, and major adverse cardiac and cerebrovascular events (MACCE ).

A supplementary analysis for the primary outcome included RCTs comparing ticagrelor monotherapy with aspirin.

Main results

Ticagrelor DAPT versus aspirin

Ticagrelor monotherapy versus aspirin


In patients undergoing CABG surgery, ticagrelor DAPT was associated with a decreased risk of saphenous vein graft failure compared with aspirin alone. However, this was accompanied by an elevated risk of clinically important bleeding. According to the authors, their study results imply “that a patient’s individual risk of graft failure, ischemic events, and bleeding needs to be weighed carefully when deciding whether to add ticagrelor to aspirin after CABG surgery.”


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Find this article online at JAMA

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