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Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis

Karla Solo1,2, Shahar Lavi3, Conrad Kabali4

  • 1Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.

BMJ (Clinical Research Ed.)
|October 12, 2019
PubMed

Insights

Adding ticagrelor or clopidogrel to aspirin significantly reduces saphenous vein graft failure after coronary artery bypass graft surgery. Tailor dual antiplatelet therapy based on patient outcomes and drug profiles.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Surgical Outcomes

Background:

  • Saphenous vein graft failure is a significant complication after coronary artery bypass graft (CABG) surgery.
  • Oral antithrombotic drugs are used to prevent graft failure, but optimal therapy remains debated.

Purpose of the Study:

  • To assess the comparative effectiveness of different oral antithrombotic drugs in preventing saphenous vein graft failure post-CABG.
  • To evaluate the safety profiles of these antithrombotic therapies regarding major bleeding, myocardial infarction, and death.

Main Methods:

  • A systematic review and network meta-analysis of randomized controlled trials.
  • Searched multiple databases (Medline, Embase, Web of Science, CINAHL, Cochrane Library) up to January 25, 2019.
  • Included trials investigating oral antiplatelets or anticoagulants for preventing saphenous vein graft failure in CABG patients.

Main Results:

  • 20 randomized controlled trials with 4803 participants were included.
  • Dual antiplatelet therapy with aspirin plus ticagrelor or aspirin plus clopidogrel showed moderate certainty evidence of reducing graft failure compared to aspirin monotherapy.
  • No significant differences in major bleeding, myocardial infarction, or death were observed among the antithrombotic therapies.

Conclusions:

  • Adding ticagrelor or clopidogrel to aspirin provides a significant absolute benefit in preventing saphenous vein graft failure post-CABG.
  • Personalized dual antiplatelet therapy selection is recommended, balancing efficacy and safety for individual patients.
Abstract

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