Should dual antiplatelet therapy be used in patients following coronary artery bypass surgery? A meta-analysis of randomized controlled trials

We assessed the effectiveness of dual antiplatelet therapy (DAPT) post elective or urgent (i.e., post acute coronary syndrome [ACS]) coronary artery bypass graft surgery (CABG). We systematically searched MEDLINE, EMBASE, and the Cochrane Registry from inception to August 2015. Randomized controlled...

Full description

Saved in:
Bibliographic Details
Published in:BMC surgery 2015-10, Vol.15 (1), p.112-112, Article 112
Main Authors: Verma, Subodh, Goodman, Shaun G, Mehta, Shamir R, Latter, David A, Ruel, Marc, Gupta, Milan, Yanagawa, Bobby, Al-Omran, Mohammed, Gupta, Nandini, Teoh, Hwee, Friedrich, Jan O
Format: Article
Language:English
Subjects:
Acute Coronary Syndrome - therapy
Angina pectoris
Cardiac patients
Care and treatment
Comparative analysis
Coronary Artery Bypass
Coronary heart disease
Drug Therapy, Combination
Health aspects
Heart attacks
Humans
Mortality
Patient outcomes
Pharmaceutical industry
Platelet Aggregation Inhibitors - therapeutic use
Postoperative Care - methods
Randomized Controlled Trials as Topic
Studies
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We assessed the effectiveness of dual antiplatelet therapy (DAPT) post elective or urgent (i.e., post acute coronary syndrome [ACS]) coronary artery bypass graft surgery (CABG). We systematically searched MEDLINE, EMBASE, and the Cochrane Registry from inception to August 2015. Randomized controlled trials (RCTs) in adults undergoing CABG comparing either dual vs. single antiplatelet therapy or higher- vs. lower-intensity DAPT were identified. Nine RCTs (n = 4,887) with up to 1y follow-up were included. Five RCTs enrolled patients post-elective CABG (n = 986). Two multi-centre RCTs enrolled ACS patients who subsequently underwent CABG (n = 2,155). These 7 RCTs compared clopidogrel plus aspirin to aspirin alone. Two other multi-centre RCTs reported on ACS patients who subsequently underwent CABG comparing higher intensity DAPT with either ticagrelor (n = 1,261) or prasugrel (n = 485) plus aspirin to clopidogrel plus aspirin. Post-operative anti-platelet therapy was started when chest tube bleeding was no longer significant, typically within 24-48 h. There were no differences in all-cause mortality in clopidogrel plus aspirin vs. aspirin RCTs; conversely, all-cause mortality was significantly lower in ticagrelor and prasugrel vs. clopidogrel RCTs (risk ratio[RR] 0.49, 95% confidence interval[CI] 0.33-0.71, p = 0.0002; 2 RCTs, n = 1695; I(2)  = 0%; interaction p 
ISSN:1471-2482
1471-2482
DOI:10.1186/s12893-015-0096-z