Beyond DAPT versus anticoagulation: methodological considerations in antithrombotic evaluation after coronary...

Comentale et al. provide a timely meta-analysis comparing anticoagulant and antiplatelet strategies after coronary endarterectomy. Their conclusion that dual antiplatelet therapy may reduce short-term myocardial infarction is clinically relevant, but several methodological issues deserve further consideration. In particular, exposure misclassification, heterogeneous myocardial infarction definitions, limited integration of bleeding outcomes, and insufficient procedural granularity may affect interpretation. Future studies should evaluate time-dependent antithrombotic exposure, standardised ischaemic and bleeding endpoints, and patient- and procedure-level modifiers to develop individualised postoperative regimens.