We assumed a common heterogeneity variance (τ2 estimated using restricted maximum likelihood approach, across the different comparisons in the network). Held C 116 Kyuchuov et al. Richard P. Whitlock: Conceptualization; Supervision; Writing—review & editing. Our website uses cookies to enhance your experience. , Eikelboom J , Jeppsson A Emilie P. Belley-Cote: Conceptualization; Methodology; Writing—original draft; Writing—review & editing. , Lorenz TJ Hage A ASA: acetylsalicylic acid; CABG: coronary artery bypass grafting; CI: confidence interval; CrI: credible interval; GRADE: Grading of Recommendations Assessment, Development and Evaluation; NMA: network meta-analysis. , Lordkipanidzé M , Liao L Tel: +1-905-5274322 ext. , French JK , Bonneau C , Kotzur J , Gottlieb S , van der Meer J et al. , Oxman AD , Vosa C. Mayer JEJr 2). We assessed statistical heterogeneity within pairwise comparisons using the I2 statistic. David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada. Circulation. The most common reasons for high risk of bias were issues with allocation concealment, participant and personnel blinding and outcome assessment blinding. , Steg PG , Bergsland J. Rafiq S , Limet R. Schunkert H, Boening A, von Scheidt M, Lanic C, Gusimi F, de Waha A et al. DAPT with clopidogrel or ticagrelor was shown to improve mortality and MACE among patients who undergo CABG after an ACS without an increase in bleeding risk [11, 12]. , Ikonomidis JS , Elveback LR Rajah SM , Connolly S Despite increasing evidence favouring the use of DAPT after CABG, its use remains controversial [13, 14]. Compared to ASA monotherapy, DAPT with ASA and clopidogrel (OR 0.60, 95% CI 0.42–0.86) and ASA and ticagrelor (OR 0.50, 95% CI 0.31–0.79) reduced SVG failure. Customize your JAMA Network experience by selecting one or more topics from the list below. We ran all models for a minimum of 100 000 iterations to ensure convergence. arrowing or occlusion is of paramount importance. Bold outcomes are statistically significant. , Mehta SR Aspirin has traditionally been the first line therapy; however, aspirin resista… Circulation. Beneficial effect of ticlopidine on early and late patency rates of venous coronary bypass grafts: a double-blind study, Improved aortocoronary bypass patency by low-dose aspirin (100 mg daily). , Asenblad N Effect on graft patency, The role of clopidogrel and acetylsalicylic acid in the prevention of early-phase graft occlusion due to reactive thrombocytosis after coronary artery bypass operation, Single vs. dual antiplatelet therapy effect on short-term graft patency postcoronary artery bypass grafting using multidetector computed tomography coronary angiography, Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (CASCADE) Trial, Prevention of aorta-coronary bypass graft occlusion. , Nicoloff DM. , Whitlock RM , Rushton L. Guyatt GH Post-operative antiplatelet therapy is an established treatment to improve graft patency and also a secondary treatment of the underlying native CAD. In contrast, coronary patients on APT undergoing coronary artery bypass graft (CABG) surgery are exposed to an excess of bleeding complications. , Glineur D , Balcon R. Goldman S , McCabe CH , Hamilton F ASA: acetylsalicylic acid. , Kootstra GJ , Peters R Antiplatelet Therapy After Coronary Artery Bypass Grafting Rahman Shah, MD; Kirstin Hesterberg, DO In Reply Drs Shah and Hesterberg raised concerns about the optimal aspirin dosage for the prevention of saphenous vein graft failure after CABG. , Olsen PS Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. Goldman S, Copeland J, Moritz T, et al. DAPT with low-dose ASA and prasugrel also reduced mortality (OR 0.25, 95% CrI 0.08–0.81; I2 = 14; high certainty, indirect evidence). What is your recommendation regarding postoperative antiplatelet therapy in this patient? , Voisine P et al. : Antiplatelet therapy in patients after CAB and coronary endarterectomy Introduction Complete myocardial revascularization is a major goal in the treatment of coronary heart disease (CHD). , Lorenz R et al. Specifically, compared to low-dose ASA monotherapy, DAPT with ASA and ticagrelor was the only combination that reduced SVG patency, mortality and MACE. Thrombelastographic haemostatic status and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial): assessing and monitoring the antithrombotic effect of clopidogrel and aspirin versus aspirin alone in hypercoagulable patients: study protocol for a randomized controlled trial. All the enrolled patients will stop oral antiplatelet drugs according to local protocol before the surgery. DAPT for patients with medically managed acute coronary syndrome 7. et al. Limet R et al. Disagreements were resolved through discussion and third-party arbitration. , Holmes DRJr , Idiz M Reoperative CABG is associated with higher perioperative risk than primary CABG—in a retrospective study of 594 redo CABG patients and 3157 primary CABG patients, the former had higher mortality (9.6% vs 2.8%; P < 0.001) [77]. Recent Canadian Guidelines recommend the use of dual antiplatelet therapy for 1 year after coronary artery bypass grafting in patients with acute coronary syndrome, but … We report 17 direct comparisons and 53 indirect comparisons for SVG stenosis (Supplementary Material, Table S3a), 16 direct comparisons and 62 indirect comparisons for mortality and MACE (Supplementary Material, Table S3b and c, respectively) and 11 direct comparisons and 38 indirect comparisons for major bleeding (Supplementary Material, Table S3d). , Short MA Coronary angiography or computed tomography angiography were used to assess grafts in 34 trials (Table 1, Fig. , Gerry S , Walker D Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting. (A) Network reporting saphenous vein graft patency outcomes. Lower rates of SVG occlusion with DAPT are offset by a higher rate of major bleeding. MACE was reported in 29 trials (Table 3, Fig. In recent guidelines, dual antiplatelet therapy (DAPT) with ASA and a P2Y 12 antagonist is recommended for all patients with ACS for at least 12 months. , Mayo J 2018;320(10):1036–1037. , Dagenais GR analysis, Copyright © 2020 European Association for Cardio-Thoracic Surgery. SVG patency is a crucial outcome after CABG. , Bandyopadhyay R While clear evidence exists for the use of aspirin in maintaining graft patency, the role of dual-antiplatelet therapy in CABG patients is not as well established. Statin therapy has been shown to reduce saphenous vein graft disease progression over the ensuing years after bypass. Preoperative Ticagrelor administration leads to a higher risk of , Rees M The analysis demonstrated that, compared to low-dose ASA monotherapy, DAPT significantly reduces SVG stenosis, based on the evidence of low and very low certainty. et al. Christenson JT randomized 21 162 patients with prior myocardial infarction (MI) 1:1:1 to DAPT with low-dose ASA with either ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily or placebo for 3 years. , Kopjar T Unfortunately, early results from clin-ical studies were frustrating [2]. © The Author(s) 2020. , Fee HJ A placebo-controlled, randomized study, Long term clinical outcome of coronary surgery and assessment of the benefit obtained with postoperative aspirin and dipyridamole, Saphenous vein graft patency 1 year after coronary artery bypass surgery and effects of antiplatelet therapy. 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