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Optimal dual antiplatelet therapy for coronary artery bypass grafting: a systematic review and meta-analysis
Ali Salman1, Saad Ahmed Waqas1, Jazza Aamir1
1Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Insights
Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor in coronary artery bypass grafting (CABG) patients improves survival and reduces bleeding. Prasugrel use in CABG patients increases bleeding risk, warranting caution.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Dual antiplatelet therapy (DAPT) is crucial for patients undergoing coronary artery bypass grafting (CABG).
- Comparing the efficacy and safety of different DAPT regimens is essential for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of DAPT using aspirin with ticagrelor, clopidogrel, or prasugrel in CABG patients.
- To determine the optimal DAPT strategy for improving survival and minimizing bleeding complications.
Main Methods:
- A meta-analysis of nineteen studies involving 9,585 patients was conducted.
- Included studies compared DAPT regimens in the context of CABG surgery.
Main Results:
- Ticagrelor significantly reduced all-cause mortality and major bleeding when stopped appropriately before surgery.
- Prasugrel was associated with an increased need for platelet transfusions.
- No significant differences were observed for myocardial infarction, stroke, or red blood cell transfusion.
Conclusions:
- DAPT with aspirin and ticagrelor provides the best balance of efficacy and safety in CABG patients.
- Prasugrel use in CABG patients should be approached with caution due to increased bleeding risks.
Introduction:
This meta-analysis evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin combined with ticagrelor, clopidogrel, or prasugrel in coronary artery bypass grafting (CABG) patients.
Methods:
Nineteen studies involving 9,585 patients were included.
Results:
Post-CABG administration of ticagrelor significantly reduced all-cause mortality (OR = 0.49 [0.33, 0.73]; p < 0.01) and minimized major bleeding when discontinued more than 3 days before surgery (OR = 0.62 [0.47, 0.83]; p < 0.01). Ticagrelor exhibited a non-significant trend toward reducing both re-bleeding and the need for platelet transfusions. Prasugrel was associated with a higher requirement for platelet transfusions (OR = 1.88; 95% CI: 1.24-2.87; p < 0.01). No significant associations were found for myocardial infarction, stroke, or RBC transfusion.
Conclusions:
In CABG patients, DAPT with aspirin and ticagrelor offers the best balance between efficacy and safety, improving key outcomes while managing bleeding risk. Prasugrel's increased bleeding risk requires caution in its use.
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