Dual versus single antiplatelet therapy after coronary artery bypass graft surgery: An updated meta-analysis

• Published in: International journal of cardiology 2018-10, Vol.269, p.80-88
• Main Authors: Cardoso, Rhanderson, Knijnik, Leonardo, Whelton, Seamus P., Rivera, Manuel, Gluckman, Ty J., Metkus, Thomas S., Blumenthal, Roger S., McEvoy, John W.
• Format: Article
• Language: English
• Subjects: Aspirin - administration & dosage; Clopidogrel; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Artery Bypass - trends; Coronary artery bypass graft surgery; Coronary Artery Disease - drug therapy; Coronary Artery Disease - mortality; Coronary Artery Disease - surgery; Drug Therapy, Combination; Dual antiplatelet therapy; Graft occlusion; Hemorrhage - chemically induced; Hemorrhage - mortality; Humans; Major bleeding; Mortality; Observational Studies as Topic - methods; Platelet Aggregation Inhibitors - administration & dosage; Randomized Controlled Trials as Topic - methods; Ticagrelor
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.07.083

The potential benefit and risks of dual antiplatelet therapy (DAPT) over single antiplatelet therapy (SAPT) in patients who undergo coronary artery bypass graft surgery (CABG) is controversial. We performed a systematic review and meta-analysis of observational and randomized clinical trial (RCT) data comparing DAPT to SAPT following urgent or elective CABG. Subanalyses were performed restricted to: a) RCTs; b) stable ischemic heart disease (SIHD); c) extended duration DAPT (≥6 months); and d) follow-up ≥2 years. Twenty-two studies comprising 20,315 patients undergoing CABG were included. Of the participants studied, 7481 (37%) received postoperative DAPT and 12,834 (63%) received SAPT. Overall, DAPT was associated with a lower cardiovascular (CV) mortality (OR 0.67; p = 0.02) and a trend towards lower all-cause mortality (OR 0.78; p = 0.08). There were no differences in rates of myocardial infarction or stroke. Subanalyses in RCTs, SIHD, and prolonged follow-up failed to demonstrate improvement in these outcomes with DAPT. However, in studies with extended duration DAPT, stroke was significantly reduced in the DAPT group (OR 0.47; p = 0.04). Saphenous vein graft (SVG) occlusion up to 1 year after CABG was significantly lower with DAPT overall (OR 0.64; p