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Updated: Oct 8, 2025
Vein Interposition Model: A Suitable Model to Study Bypass Graft Patency
Published on: January 15, 2017
Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial
Alexander Kulik1, Amy M Abreu1, Viviana Boronat1
1Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic University, Boca Raton, Florida, USA.
Insights
Ticagrelor did not significantly reduce saphenous vein graft occlusion one year after coronary artery bypass graft surgery compared to aspirin. Further research will examine 2-year graft patency in this patient group.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Antiplatelet therapy is crucial for preventing saphenous vein graft (SVG) occlusion post-coronary artery bypass graft (CABG) surgery.
- Optimal antiplatelet regimens following CABG remain under investigation.
- The TARGET trial aimed to compare ticagrelor with aspirin for SVG occlusion reduction.
Purpose of the Study:
- To evaluate if early postoperative ticagrelor reduces SVG occlusion compared to aspirin therapy.
- To assess graft patency and major adverse cardiovascular events at one year post-CABG.
Main Methods:
- A multi-center, double-blind, randomized trial involving 250 patients undergoing CABG with SVG.
- Patients received either aspirin 81 mg twice daily or ticagrelor 90 mg twice daily.
- The primary outcome was SVG occlusion assessed at one year.
Main Results:
- One-year SVG occlusion rates were similar between ticagrelor (13.2%) and aspirin (17.4%) groups (p=0.30).
- No significant differences were observed in overall graft disease or major adverse cardiovascular events between the groups.
- 80.8% of patients completed the one-year graft assessment, evaluating 588 grafts.
Conclusions:
- Ticagrelor did not demonstrate a significant reduction in SVG occlusion at one year compared to aspirin after CABG.
- The study suggests current antiplatelet strategies may not be sufficient to prevent SVG disease progression.
- Further investigation into 2-year graft patency for this cohort is warranted.
Background:
Antiplatelet therapy prevents saphenous vein graft (SVG) occlusion and improves outcomes after coronary artery bypass graft surgery (CABG). However, the optimal postoperative antiplatelet regimen remains unclear. The goal of the Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) trial was to assess whether early postoperative ticagrelor reduces SVG occlusion compared to conventional aspirin therapy.
Methods:
In this multi-center double-blind randomized trial, 250 patients who had CABG with SVG were randomized to receive either aspirin 81 mg twice daily or ticagrelor 90 mg twice daily. The primary outcome was SVG occlusion at 1 year.
Results:
Altogether, 123 patients were randomized to aspirin and 127 received ticagrelor. One-year graft assessment was performed in 202 patients (80.8%), examining 588 grafts, yielding an overall graft occlusion rate of 10.9%. The primary outcome, SVG occlusion at 1 year, did not significantly differ between the two groups (17.4% vs. 13.2%, aspirin vs. ticagrelor, p = .30). The incidence of vein grafts with any disease (stenosis or occlusion) did not significantly differ between the groups (21.5% vs. 22.3%, aspirin vs. ticagrelor, p = .90), and the number of patients with vein graft disease did not significantly differ between the groups (29.4% vs. 28.0%, aspirin vs. ticagrelor, p = .88). Freedom from major adverse cardiovascular events at 1 year was similar between the groups (p = .60).
Conclusions:
Compared to conventional aspirin therapy, ticagrelor did not significantly reduce vein graft occlusion 1 year after CABG. Further study will assess the impact of ticagrelor on 2-year graft patency for this cohort.
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