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Updated: Jun 30, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Antithrombotic strategies for preventing graft failure in coronary artery bypass graft
Maria Sara Mauro1, Simone Finocchiaro1, Dario Calderone1
1Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Via Santa Sofia, 78, Catania, Italy.
Insights
Optimal antithrombotic strategies after coronary artery bypass grafting (CABG) remain unclear. This review of randomized trials evaluates antiplatelet and anticoagulation therapies to improve graft patency and reduce adverse events.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Clinical Trials
Background:
- Coronary artery bypass grafting (CABG) is challenged by graft failure due to thrombosis, hyperplasia, and atherosclerosis.
- Optimal antithrombotic therapy post-CABG is uncertain, lacking definitive guidelines and relying on expert opinion.
- Graft occlusion significantly impacts long-term patient outcomes after CABG.
Purpose of the Study:
- To review randomized clinical trials and meta-analyses on antithrombotic therapy in CABG patients.
- To evaluate the efficacy and safety of various antithrombotic regimens for preventing graft failure.
- To inform clinical decision-making regarding antithrombotic strategies after CABG.
Main Methods:
- Systematic review of randomized clinical trials and meta-analyses.
- Analysis of antithrombotic strategies including single antiplatelet therapy (aspirin, P2Y12 inhibitors), dual antiplatelet therapy, and anticoagulation.
- Evaluation of graft patency, major adverse cardiovascular events, and bleeding complications.
Main Results:
- Aspirin is established as a cornerstone of post-CABG antithrombotic therapy.
- Adding P2Y12 inhibitors to aspirin has shown mixed results in randomized controlled trials.
- The optimal balance between preventing graft occlusion and minimizing bleeding risk requires further investigation.
Conclusions:
- Current evidence on optimal antithrombotic strategies post-CABG is inconclusive.
- Further research is needed to establish definitive guidelines for antithrombotic therapy after CABG.
- Personalized antithrombotic approaches may be necessary to optimize long-term CABG outcomes.
Abstract:
Coronary artery bypass graft (CABG) procedures face challenges related to graft failure, driven by factors such as acute thrombosis, neointimal hyperplasia, and atherosclerotic plaque formation. Despite extensive efforts over four decades, the optimal antithrombotic strategy to prevent graft occlusion while minimizing bleeding risks remains uncertain, relying heavily on expert opinions rather than definitive guidelines. To address this uncertainty, we conducted a review of randomized clinical trials and meta-analyses of antithrombotic therapy for patients with CABG. These studies examined various antithrombotic regimens in CABG such as single antiplatelet therapy (aspirin or P2Y12 inhibitors), dual antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes including the patency of grafts, major adverse cardiovascular events, and bleeding complications and also explored future perspectives to enhance long-term outcomes for CABG patients. Early studies established aspirin as a key component of antithrombotic pharmacotherapy after CABG. Subsequent randomized controlled trials focused on adding a P2Y12 inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin, yielding mixed results. This article aims to inform clinical decision-making and guide the selection of antithrombotic strategies after CABG.
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