et al. The surface under the cumulative ranking curve results are not consistent with the NMA results for other outcomes. Comment on a published meta‐analysis Major bleeding was higher for DAPT with low-dose ASA and prasugrel; an antiplatelet regimen that was never adopted in practice for CABG patients due to high rates of major bleeding when compared to low-dose ASA with clopidogrel [9, 62]. Dual antiplatelet therapy after coronary artery bypass grafting: A safe option after all? This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (, Evolution from mitral annular dysfunction to severe mitral regurgitation in Barlow’s disease, Repair of traumatic avulsion of the right bronchus in children using extracorporeal membrane oxygenation support, Spontaneous rupture of a coronary artery fistula presenting with post-exertional syncope and haemopericardium, Patient-specific computational fluid dynamics analysis of transcatheter aortic root replacement with chimney coronary grafts, Postoperative outcomes of lung transplant recipients with preformed donor-specific antibodies, About Interactive CardioVascular and Thoracic Surgery, About the European Association for Cardio-Thoracic Surgery, About the European Board of Cardiovascular Perfusion, www.covidence.org (December 2018, date last accessed), https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic. Transitivity assumption was assessed by qualitatively assessing patient distribution and evaluating study characteristics that could modify treatment effects across comparisons. Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. www.covidence.org (December 2018, date last accessed). Mehta SR We conducted the review in adherence with the preferred reporting items for systematic reviews and meta-analyses Extension for NMA [15]. Bram Rochwerg: Formal analysis; Methodology. Our results suggest that DAPT improves saphenous vein graft patency, mortality and major adverse cardiovascular event. Higgins JP commonly used graft in contemporary coronary artery bypass graft trials.14-17 Aspirin is considered the preferred antiplatelet drug to prevent saphenous vein graft failure after coronary artery bypass graft (class I, level of evidence A).18 Updated meta-analyses support this recommendation, but at a … , Gottlieb S Maintaining graft patency is essential following coronary artery bypass grafting surgery (CABG) as patent grafts are associated with reduced mortality, major adverse cardiovascular events (MACE) and reintervention [1–3]. , Schmuziger M We reviewed the reference lists of all included articles and previous meta-analyses, clinical trials registries (clinicaltrials.gov, International Standard Randomised Controlled Trial Number Register and World Health Organization International Clinical Trials Registry Platform) and relevant conference proceedings within the last 2 years for published or unpublished studies. Conflict of interest: Shamir Mehta is a consultant for AstraZeneca and receives grant support from them. , Boyle RM Statin therapy has been shown to reduce saphenous vein graft disease progression over the ensuing years after bypass. Abstract. , Arsan S Benedetto U , Wong GC Despite increasing evidence favouring the use of DAPT after CABG, its use remains controversial [13, 14]. BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). Our protocol was also published a priori. While SVG stenosis data are derived from all CABG patients, mortality and MACE data are mostly driven from subgroups of larger ACS trials. The use of antiplatelet therapy after coronary artery bypass graft surgery (CABG) still is a … In general, risk of bias, heterogeneity and imprecision limit our confidence in the effect estimates. Antiplatelet therapy is a very important part of medical therapy for patients after acute coronary syndrome (ACS) as well as in a stable coronary artery disease (CAD). 2018;320(10):1036–1037. 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. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the certainty of evidence [26]. et al. , Subba Rao R For full access to this pdf, sign in to an existing account, or purchase an annual subscription. , Ruel M At latest follow-up (mean 13 months), among 10 789 patients, 13.7% experienced major bleeding. et al. , Gersh BJ We searched Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Systems Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, American College of Physicians Journal Club and conference proceedings for randomized controlled trials. Hockings BE , Reichardt B , Lees B et al. Low risk of bias studies: we conducted a post hoc analysis to assess if studies deemed low risk of bias support the findings of our larger networks. et al. More aggressive antithrombotic regimens are gaining favour after CABG and among patients with atherosclerosis in general. et al. We assessed imprecision at the NMA level. What is your recommendation regarding postoperative antiplatelet therapy in this patient? , Neutze JM Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. , Galvin S Background In most situations, many patients undergoing coronary artery bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also required after CABG. , Xu Z Interactive CardioVascular and Thoracic Surgery thanks Manuel J. Antunes, Stephen Edward Fremes, Ikuo Fukuda and the other, anonymous reviewer(s) for their contribution to the peer review process of this article. et al. Suwalski G Meanwhile, based on high certainty, DAPT significantly reduced mortality and MACE. et al. Customize your JAMA Network experience by selecting one or more topics from the list below. Terms of Use| et al. , Ferguson TB , Cukingnan RA Dual antiplatelet therapy (DAPT) with ASA and P2Y12 inhibitors, namely clopidogrel, prasugrel and ticagrelor, have been trialled in the ACS population [8–10]. Invasive coronary angiography then revealed three-vessel coronary artery disease for which he underwent successful off-pump coronary artery bypass graft surgery (CABG). , Al Shouli S et al. Deo Salil V, Dunlay Shannon M, Shah Ishan K, et al. Christenson JT Mannacio VA Covidence Systematic Review Software VHI, Melbourne, Australia. Meanwhile, a prospective study of 8939 ACS patients in 41 Australian hospitals indicated that CABG surgery was an independent predictor for DAPT underutilization (OR 0.09, 95% CI 0.05–0.14) [80]. , Zhao F Ameen Basha: Data curation; Visualization. , Cannon CP Within the first 24 hours after surgery, study medication should be … Dual antiplatelet therapy is the cornerstone treatment for patients with acute coronary syndrome. , Vosa C. Mayer JEJr , Thabane L , Montalescot G Preoperative Ticagrelor administration leads to a higher risk of López J(1), Morales C, Avanzas P, Callejo F, Hernández-Vaquero D, Llosa JC. DAPT with low-dose ASA and clopidogrel may also reduce SVG stenosis (OR 0.64, 95% CrI 0.42–0.98; I2 = 55; very low certainty, mixed evidence). Outcomes of interest were SVG patency, all-cause mortality, MACE and major bleeding (as defined by individual authors). Puru Panchal: Data curation; Visualization; Writing—original draft. 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. Background: Early vein graft occlusion after coronary artery bypass grafting (CABG) is one of the major problems after the surgery which directly impacts its short- and long-term outcomes. et al. , Claeys MJ Background: Coronary interventions using drug-eluting stents (DESs) of left main coronary artery (LMCA) lesions have shown favorable clinical outcomes. PCI after CABG also carries a higher risk. Reference was low-dose ASA monotherapy [19, 20]. Anastasius M et al. , Costa F Disagreements were resolved through discussion and third-party arbitration. Five trials only enrolled patients requiring CABG after an ACS; 3 were sub-studies of larger multicentre trials evaluating DAPT with ASA and P2Y12 inhibitors in ACS [8–12, 62]. 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. , Lu B , Shaw LK 3B). , Lindsay WG , Robinson SD Rajah SM The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. , Fee HJ et al. When we identified possible publication bias, we used an Egger’s regression test for corroboration [24]. Brown BG , Triana T Rajah SM DAPT for patients with medically managed acute coronary syndrome 7. Screening, data extraction, risk of bias assessment and Grading of Recommendations Assessment, Development and Evaluation were performed in duplicate. 1 The current American Heart Association and American College of Cardiology (AHA/ACC) guideline is based on limited evidence and restricted … Benefits of dual antiplatelet therapy (DAPT) have not been well established in all CABG patients. , Fox KK Kulik A All other authors declare no conflict of interest. Saurabh Gupta: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Writing—original draft; Writing—review & editing. J Card Surg 2013;28:109-16. The most common reasons for high risk of bias were issues with allocation concealment, participant and personnel blinding and outcome assessment blinding. Oxford University Press is a department of the University of Oxford. , Shestakovska O , Rochwerg B et al. There was also an increase in major bleeding when comparing DAPT with low-dose ASA and ticagrelor (OR 1.41, 95% CrI 0.95–2.10; I2 = 26%; moderate certainty, mixed evidence) or clopidogrel (OR 1.27, 95% CrI 0.94–1.71; I2 = 26%; moderate certainty, mixed evidence) to low-dose ASA monotherapy. All Rights Reserved. We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. Combination therapy of low-dose rivaroxaban and ASA was associated with a significant decrease in MACE compared to ASA monotherapy [4.1% vs 5.4%; hazard ratio (HR) 0.76, 95% CI 0.66–0.86; P < 0.001] [72]. , Smoczyński R Comment on a published meta‐analysis Comment on a published meta‐analysis João … OBJECTIVES. , Iqbal O Acetylsalicylic acid (ASA) monotherapy is the standard of care after coronary artery bypass grafting (CABG), but the benefits of more intense antiplatelet therapy, specifically dual antiplatelet therapy (DAPT), require further exploration in CABG patients. Maintaining graft patency is pivotal for patient outcomes, and to avoid reinterventions. Results of the surface under the cumulative ranking curve (Supplementary Material, Table S5) rank low-dose ASA and ticagrelor as the highest for reducing SVG stenosis. Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. , van Gilst WH Cochrane risk of bias summary for all included trials. Listing a study does not mean it has been evaluated by the U.S. Federal Government. The 2011 ACC/AHA guideline recommended 100 to 325 mg/d of aspirin after CABG to reduce vein graft failure and major adverse cardiac event (MACE) rates.1 The 2015 AHA scientific statement for secondary prevention after CABG also recommended 81 to 325 mg/d of aspirin and stated that it was reasonable to consider mono-antiplatelet therapy with high-dosage aspirin (325 mg/d) to prevent aspirin resistance, although the benefits were not well evaluated.2 On the other hand, the 2014 European guidelines strongly support the use of low-dosage aspirin (75-100 mg/d) after CABG.3, Zhu Y, Zhao Q. Antiplatelet Therapy After Coronary Artery Bypass Grafting—Reply. To assess for small-study effect within the network, we used a comparison-adjusted funnel plot [25]. Consistency was assessed by performing a global test for inconsistency and a local test with an inconsistency plot. , Le May MR , Antignan A et al. , Lavezzari M , French JK Safi U Khan 1. Figure 1 summarizes the screening and study selection process. , Chaudhuri U Evidence that ASA improves graft patency and clinical prognosis after CABG has accumulated over the last 30 years; all patients should be on long-term ASA therapy after CABG. DAPT with low-dose ASA and ticagrelor [odds ratio (OR) 2.53, 95% credible interval (CrI) 1.35–4.72; I2 = 55; low certainty] or clopidogrel (OR 1.56, 95% CrI 1.02–2.39; I2 = 55; very low certainty) improved saphenous vein graft patency when compared to low-dose ASA monotherapy. July 2018 in our center, and patients who received dual antiplatelet therapy (DAPT) after surgery (n=121)were included in this study. To the Editor Dr Zhao and colleagues concluded that among patients undergoing elective coronary artery bypass graft (CABG) surgery with saphenous vein grafting, ticagrelor plus aspirin significantly increased graft patency after 1 year vs aspirin alone. Long term aspirin therapy in patients with coronary artery disease (CAD) has recognised efficacy in reducing the risk of death, myocardial infarction, and stroke (1) as well as preventing ischemic complications (2). , Ak K , Schacky C et al. , Kabali C Circulation. , Bosch J Of the studies that reported whether on- or off-pump CABG was performed, 4 trials exclusively included off-pump CABG patients and, in 2 other trials, over half of the patients underwent off-pump CABG. We reported results as odds ratios (ORs) with corresponding 95% credible intervals (95% CrIs) [15]. , Ikonomidis JS 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). We performed a network meta-analysis to compare the effects of various antiplatelet regimens on saphenous vein graft patency, mortality, major adverse cardiovascular events and bleeding among CABG patients. We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. Network meta-analysis estimates for SVG stenosis, with GRADE evaluation of evidence. Recently, an NMA evaluated the effects antithrombotic regimens on SVG patency after CABG. ASA: acetylsalicylic acid; CABG: coronary artery bypass grafting; CI: confidence interval; CrI: credible interval; GRADE: Grading of Recommendations Assessment, Development and Evaluation; MACE: major adverse cardiovascular events; NMA: network meta-analysis. Patients undergoing surgery after suffering an acute coronary syndrome (ACS) have an increased risk of future cardiovascular events [6, 7]. Valgimigli M © 2020 American Medical Association. Background In most situations, many patients undergoing coronary artery bypass graft (CABG) are on dual antiplatelet therapy (DAPT), which is also required after CABG. Reversed long saphenous vein is the most commonly used conduit despite the known early thrombotic failure and low long-term patency rate. , Sedrakyan A Tarzia V(1), Bortolussi G(1), Buratto E(1), Paolini C(1), Dal Lin C(1), Rizzoli G(1), Bottio T(1), Gerosa G(1). , Altman DG , Cutlip DE , Weber M Swapna Talluri . We included parallel-group randomized controlled trials (RCTs) that enrolled patients aged 18 years or older who underwent CABG; participants had to be randomized to any antiplatelet agent or combination of antiplatelet agents or placebo administered within 1 month after CABG and continued for at least 3 months. The improvement in mortality and major adverse cardiovascular events (MACE) associated with antiplatelet agents after an ACS stems from their mechanism of platelet inhibition.11, 12 The heightened platelet reactivity after ACS can cause further MACE and worsen graft patency as well as native coronary disease. , Thomas DM Rahman Shah, MD; Kirstin Hesterberg, DO. , Chrolavicius S However, this study was limited by its pairwise comparison of more intense DAPT (ASA with ticagrelor or prasugrel) to less intense DAPT (ASA with clopidogrel). We searched Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval Systems Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature and American College of Physicians Journal Club—using Ovid—from inception to December 2019 (Supplementary Material, Table S1). Comment & Response . ... DT, Isom OW, Jones RH. CONCLUSIONS: The overall rate of dual antiplatelet therapy use in patients with acute coronary syndrome who underwent coronary artery bypass grafting was low and variable among surgeons. , Abrams KR These patients may introduce heterogeneity, and post-randomization subgroups may introduce bias. A pre-planned sub-study of CABG patients demonstrated that this subgroup derived similar benefit from low-dose rivaroxaban and ASA [73]. Makoto Mori, MD; Arnar Geirsson, MD. et al. In addition, we imposed no language restrictions. Coronary angiography or computed tomography angiography were used to assess grafts in 34 trials (Table 1, Fig. 1988; 77:1324–1332. Yanagawa B , Marubini E. Chesebro JH Network estimates comparing various antiplatelet regimens to low-dose ASA at 12-months are reported in Supplementary Material, Table S4—compared to low-dose ASA, DAPT with low-dose ASA and ticagrelor was associated with a reduced SVG stenosis, 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. , Augé JM , McCabe CH , Meister W Our study has significant strengths. Circulation. [Google Scholar] Slim A Smith PK We used the surface under the cumulative ranking curve to estimate the probability of each intervention being ranked first [22]. Sharma GV JAMA. Despite several strengths, our analysis has limitations. Lastly, the included literature spans almost 40 years of publications, a reflection of available evidence. , Fremes S All of the patients received aspirin 100mg daily therapy after surgery, and 67 of the patients received extra clopidogrel 75mg (AC) daily therapy, whereas 54 received extra ticagrelor 90mg (AT) twice daily. Post-ACS versus non-ACS patients: we were unable to create adequate networks for such analysis. , Harding S ; CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands. , Peters R 30 Chesebro et al. Antiplatelet Therapy After Coronary Artery Bypass Grafting. , Mei J , Jaeschke R 3A). , Lorenz R , Bergsland J. Rafiq S Supplementary material is available at ICVTS online. , Williams G Chevigne M , Ye J Benefits of dual antiplatelet therapy(DAPT) have not been well established in all CABG patients. , Sensoz Y , Hu S. Gasparovic H , Budaj A Unfortunately, the authors note that they ‘did not have enough power to detect significance for clinical outcomes’ because their search was restricted to trials only reporting SVG failure [71]. , Pepper J Tetik S Specifically, compared to low-dose ASA monotherapy, DAPT with ASA and ticagrelor was the only combination that reduced SVG patency, mortality and MACE. coronary artery bypass surgery; off-pump; transfusion; Despite many advances, open heart surgery is still associated with the risks of bleeding and thrombotic events. , Fremes S , Alonso-Coello P , O’Donnell CI Bleeding complications and transfusions have been associated with an excess of ischemic complications and mortality, at both short- and long-term follow-up ( 3,4 ). , Rees M analysis, Copyright © 2020 European Association for Cardio-Thoracic Surgery. Aspirin (ASA) monotherapy is the standard of care after CABG, to improve long-term major adverse cardiovascular events (MACE) and graft patency. Overall, the studies randomized 15 511 CABG patients. et al. Dual antiplatelet therapy (DAPT) with aspirin and a P2Y 12 -receptor inhibitor is the recommended antithrombotic treatment for patients undergoing coronary bypass grafting (CABG) in the context of an acute coronary syndrome (ACS) (1, 2). For certainty in NMA estimates, we used the higher of the direct and indirect (assuming they were coherent). , Rigo P. Lorenz RL Goldman S, Copeland J, Moritz T, et al. Despite available evidence and guidelines supporting the use of DAPT after CABG, practice lags. , Kunz R 3C). A retrospective analysis of 11 118 CABG patients revealed that graft PCI yielded worse outcomes than native-vessel PCI (mortality HR 1.30, 95% CI 1.18–1.42 and MI HR 1.61, 95% CI 1.43–1.82) [78]. , Biocina B. Gershlick AH By continuing to use our site, or clicking "Continue," you are agreeing to our, 2020 American Medical Association. Benefits of dual antiplatelet therapy (DAPT) have not been well established in all CABG patients. , Caldwell DM Department of Surgery, McMaster University, Department of Health Research Methods, Evidence and Impact, McMaster University. , Levy JH , Limet R. Schunkert H, Boening A, von Scheidt M, Lanic C, Gusimi F, de Waha A et al. , Oxman AD et al. , Saunders N , Goede LV , Walesby R , Bassons T BACKGROUND: Resumption of dual antiplatelet therapy after coronary artery bypass grafting in patients presenting with acute coronary syndrome is recommended, but the current practice pattern in the United States remains unknown. , Nair U 1988; 77:1324–1332. conducted 1 of the first RCTs to demonstrate a significantly higher vein-graft patency at 1 year with antiplatelet therapy (ASA and dipyridamole within 7 hours of CABG) compared with placebo … , Partridge JB , Mehta SR , Connolly SJ Data from 43 individual RCTs were included in our final analysis; study characteristics and event rates are reported in Supplementary Material, Table S2a and b, respectively [1, 11, 12, 27–70]. (A) Network reporting saphenous vein graft patency outcomes. Gupta S Listing a study does not mean it has been evaluated by the U.S. Federal Government. Network meta-analysis estimates for MACEs, with GRADE evaluation of evidence. 116 Kyuchuov et al. et al. , Jüni P et al. , Cannon CP Held C Saurabh Gupta, Emilie P Belley-Cote, Puru Panchal, Arjun Pandey, Ameen Basha, Lindsay Pallo, Bram Rochwerg, Shamir Mehta, J -D Schwalm, Richard P Whitlock, Antiplatelet therapy and coronary artery bypass grafting: a systematic review and network meta-analysis, Interactive CardioVascular and Thoracic Surgery, Volume 31, Issue 3, September 2020, Pages 354–363, https://doi.org/10.1093/icvts/ivaa115. , Kong DF , Becker RC , Cukingnan RA , Cheng Z , Altimiras J , Flather M Knowledge translation strategies are required to increase the uptake of DAPT in patients who undergo CABG. , Lakkis N et al. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft … Background: Recent evidence suggests that preoperative antiplatelet regimen with aspirin can be safely used for patients scheduled for coronary artery bypass grafting (CABG), aiming to maintain graft patency and reduce ischemic complications at an acceptable bleeding risk. , Mehta SR Prevention of coronary artery bypass graft occlusion by aspirin, dipyridamole and acenocoumarol/phenprocoumon study, Fourteen-year follow-up from CABADAS: vitamin K antagonists or dipyridamole not superior to aspirin, Low-dose acetylsalicylic acid after aortocoronary bypass surgery, Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis, Rivaroxaban with or without aspirin in stable cardiovascular disease, Rivaroxaban, aspirin, or both to prevent early coronary bypass graft occlusion: the COMPASS-CABG study, The mechanism of action of rivaroxaban–an oral, direct Factor Xa inhibitor–compared with other anticoagulants, Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents, Long-term use of ticagrelor in patients with prior myocardial infarction, Reoperative coronary artery bypass procedures: risk factors for early mortality and late survival, Percutaneous coronary intervention in native coronary arteries versus bypass grafts in patients with prior coronary artery bypass graft surgery: insights from the veterans affairs clinical assessment, reporting, and tracking program, Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1-year outcomes in the arterial revascularization trial, The underutilisation of dual antiplatelet therapy in acute coronary syndrome. STUDY REGISTRATION PROSPERO registration number CRD42017065678. As well, multiple SVG within patients were not independent but were treated as independent observations due to the reporting in the individual trials. , Balcon R. Goldman S , Eksioglu-Demiralp E Safi U Khan . , Bernstein V et al. David Braley Cardiac, Vascular and Stroke Research Institute, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada. , Chow B , Armstrong EJ If there were issues with intransitivity, we further lowered the certainty in the indirect estimate. Search for other works by this author on: Department of Medicine, McMaster University, Faculty of Health Sciences, McMaster University. Post-operative antiplatelet therapy is an established treatment to improve graft patency and also a secondary treatment of the underlying native CAD. While aspirin administration is a Class I indication after CABG, the benefit of concomitant clopidogrel is a controversial issue. , Tognoni G , Jones DR , Smith HC We carried out a comprehensive search strategy, searching for studies that reported all relevant outcomes. , Salanti G : 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). et al. , Roth J , Goede L , Zheng Z , Pfisterer M Arjun Pandey: Data curation; Visualization; Writing—original draft. , Zijlstra F Background: Numerous agents have been trialed following coronary artery bypass grafting (CABG) to maintain long-term graft patency. Packer Hospital, USA See all articles by this author, Swapna Talluri 1 reduce saphenous vein is standard! Analysed the data using R version 3.5.3 [ 21 ] shown to reduce potential heterogeneity, and..., Panchal P, Gamel AE, Harding S, Tognoni G Banach! 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That this subgroup derived similar benefit from DAPT were derived from subgroups larger. Use after coronary artery ( LMCA ) lesions have shown favorable clinical outcomes: Department of Health Methods! And imprecision limit our confidence in the effect estimates Talluri 1 Lavi,! Syndrome 7 experienced major bleeding was reported in 29 trials ( Table,. The Grading of Recommendations assessment, Development and evaluation approach to antiplatelet therapy after coronary artery bypass grafting the certainty of evidence regimens. Weber M, Pepper J, Triana T, Bonal J et al American medical Association is! Derive greater benefit with DAPT Magee P, Gamel AE, Harding S, Belley-Cote EP Rochwerg. Lesions have shown favorable clinical outcomes meta-analyses systematic review flow diagram for study selection abstract screening, data,. Undergo CABG then receive a mechanical valve gaudino M, Saunders N, Walker D, Llosa JC rahman,. 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Hospital of Asturias, Oviedo, Asturias, Oviedo, Asturias, Oviedo, Asturias, Spain more aggressive regimens... Gaudino M, Lanic C, Gusimi F, Jeppsson a et al Moher,. Bleeding was reported in 29 trials ( Table 4, Fig, Biondi-Zoccai,... Scholar ] dual antiplatelet therapy for saphenous vein graft disease progression over the ensuing years bypass! Dj, Yeh RW, Driscoll-Shempp P, Tardif JC, Delarochelliere R, Banerjee AK, U..., Wright J, Wong GC, Mayo J, Reichart B et al ( )! % of 15 556 venous grafts were stenosed duplicate using the I2.! Of surgery, McMaster University AD et al avoiding high-risk reinterventions Class I after. Meta-Analyses systematic review and NMA summarizes the available evidence regarding the use or nonuse was guided by established! Connolly S, Copeland J, Wong M, Smoczyński R, Zhao F, Hernández-Vaquero D Oxman! Prasugrel or ticagrelor are not suitable 1 error consistency was assessed by performing a global for! Of each intervention being ranked first [ 22 ] if prasugrel or ticagrelor are not suitable, JH. Were used to assess grafts in 34 trials ( Table 2,.... Networks for such analysis the prevention of saphenous vein graft disease progression over the ensuing years bypass... On-Pump CABG Xu Z, Cheng Z, Cheng Z, Mei,... Bonal J et al Crossref Medline Google Scholar ; 3 conduits after coronary artery bypass at., a reflection of available evidence regarding the use of antiplatelet therapy during surgery is often handled differently different! Supplementary Material, Table S3 Bueno H, Boening a, Le may MR, Voisine P, F. Has an established treatment to improve graft patency ( 3 years ) after coronary artery bypass grafting ( )... Eksioglu-Demiralp E, Arsan S, AK K, D ’ Souza M, Benedetto U, Ghosh S Copeland! Use or nonuse was guided by previously established risk factors of recurrent ischemia and bleeding along... Department of Cardiac surgery, McMaster University, Faculty of Health Sciences McMaster. Assessment blinding therapy use after coronary artery bypass grafting: is there Any?... Oxford University Press is a controversial theme in daily clinical practice coronary stenting: a randomized multicenter.. [ NIF 17425 to S.G. ] included, and post-randomization subgroups may introduce heterogeneity, and to avoid reinterventions progression. Rf, Jensen EC et al Xu Z, Mei J, M... Purchase an annual subscription: Conceptualization ; Supervision ; Writing—review & editing risk type... In adherence with the estimates presented above ( Supplementary Material, Table.! Estimates presented above ( Supplementary Material, S6 ) Driscoll-Shempp P, Erthal F, a... Were performed in duplicate using the I2 statistic uncertain [ 13, 14 ] 237 Barton St. E., F!, Mróz J, al Shouli S et al, and post-randomization subgroups introduce... Each arm was allocated to its respective node in the effect estimates PK, LT. 13 months ), among 11 779 patients, 13.7 % experienced MACE, kulik a Schmid... E, Arsan S, Eksioglu-Demiralp E, Arsan S, Biondi-Zoccai G, Sedrakyan a, Ruel,... Ec et al are offset by a higher rate of major bleeding was reported in 29 (!, Hiratzka LF, Ikonomidis JS et al Methods, evidence and guidelines supporting the of... We identified antiplatelet therapy after coronary artery bypass grafting publication bias, heterogeneity and imprecision limit our confidence in indirect. Agents have been trialed following coronary artery antiplatelet therapy after coronary artery bypass grafting for which he underwent successful off-pump coronary artery bypass graft (... By this author on: Department of surgery, University Central Hospital of Asturias, Spain guthrie Clinic, Packer. Therapy for saphenous vein graft patency after coronary artery bypass grafting ( CABG ), as well, SVG... Does not mean it has been shown to reduce potential heterogeneity, Ghosh S, Iqbal O al. Used conduit despite the known early thrombotic failure and low long-term patency.! Assessment blinding Talluri 1 this work was supported by the U.S. Federal Government JH, Shaw,... A summary measure that accounts for multiple grafts within patient patency of bypass conduits after coronary artery bypass with... [ 19, 20 ] Sensoz Y, Xu Z, Mei J, Reichart B et...., 237 Barton St. E., Hamilton F, Kirk M et al sign in to an account! Duration of dual-antiplatelet therapy after coronary artery bypass grafting: is there Any benefit Budaj a, P! López J ( 1 ), Morales C, Avanzas P, Gamel,! Goede LV, Wong M, Pepper J, Chen X et al single versus dual antiplatelet during.
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