, Tsai T , Fremes S , Zheng Z , Moritz T OBJECTIVES: The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events. , Balcon R. Goldman S 5.1 DAPT in patients treated with coronary artery bypass surgery for stable coronary artery disease 5.2 DAPT in patients treated with coronary artery bypass surgery for acute coronary syndrome 5.3 DAPT for prevention of graft occlusion 5.4 Gaps in evidence 6. , Weber M 116 Kyuchuov et al. , Voisine P Mauri et al. , Penny W We only included trials evaluating antiplatelet regimens, and not anticoagulants, to reduce potential heterogeneity. , Hyun K CABADAS Research Group of the Interuniversity Cardiology Institute of the Netherlands. , Rochwerg B Saw J , Limet R. Schunkert H, Boening A, von Scheidt M, Lanic C, Gusimi F, de Waha A et al. bleeding during and after coronary bypass surgery in a case-matched et al. Disagreements were resolved through discussion and third-party arbitration. Evidence for prolonging DAPT beyond 1 year post-ACS also supports this concept. , Isbir S , Banerjee AK Circulation. Listing a study does not mean it has been evaluated by the U.S. Federal Government. We carried out a comprehensive search strategy, searching for studies that reported all relevant outcomes. R Development Core Team. et al. et al. , Rushton L. Guyatt GH Yanagawa B et al. Our website uses cookies to enhance your experience. Improvement in early saphenous vein graft patency after coronary artery bypass surgery with antiplatelet therapy: results of a Veterans Administration Cooperative Study. , Liao L , Dagenais GR 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Clinical Trials Registry Platform) and relevant conference proceedings within the last 2 years for published or unpublished studies. , Bozzo A 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]. , Kirk M , Ruel M , Djuric Z Clopidogrel 75 mg daily should be prescribed if prasugrel or ticagrelor are not suitable. et al. , Byrne RA Given the multiple comparisons, there is an increased risk for type 1 error. et al. , DeRouen T 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. [75] showed that continued treatment with clopidogrel or prasugrel beyond the 1-year after percutaneous coronary intervention (PCI) significantly reduced MACE (4.3% vs 5.9%; HR 0.71, 95% CI 0.59–0.85; P < 0.001). One of the potential explanations is aspirin resistance. , Falck-Ytter Y 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. We contacted authors of primary studies to obtain relevant non-published data. , Parisi AF. , Short MA , Zhao F , Bosch J , David JL Circulation 2012; 125: 2015–2026. Guthrie Clinic, Robert Packer Hospital, USA See all articles by this author. , Pandey A , van Gilst WH , Gøtzsche PC Comment on a published meta‐analysis , Mehta SR NMA suggests DAPT with low-dose ASA and ticagrelor may be superior to low-dose ASA monotherapy for reducing SVG stenosis (OR 0.40, 95% CrI 0.21–0.74; I2 = 55; low certainty, mixed evidence). doi: 10.1161/01.CIR.77.6.1324. , Shaw LK Lastly, the included literature spans almost 40 years of publications, a reflection of available evidence. All Rights Reserved. , Kofoed KF (A) Network reporting saphenous vein graft patency outcomes. , Lorenz R Lamy A Dual antiplatelet therapy after coronary artery bypass grafting: A safe option after all? Limet R Privacy Policy| Anastasius M et al. Supplementary material is available at ICVTS online. , Alonso-Coello P , Altman DG Meanwhile, based on high certainty, DAPT significantly reduced mortality and MACE. 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 … A pre-planned sub-study of CABG patients demonstrated that this subgroup derived similar benefit from low-dose rivaroxaban and ASA [73]. 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]. , Smoczyński R 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. R: A Language and Environment for Statistical Computing. Benefits of dual antiplatelet therapy(DAPT) have not been well established in all CABG patients. , Lorenz TJ 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. DAPT with low-dose ASA and prasugrel also reduced MACE (OR 0.50, 95% CrI 0.26–0.97; I2 = 0; high certainty, indirect evidence). Mehta SR 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). , Lavi S , Xu Z , Gamel AE 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. It seems that while cardiac surgeons appropriately stop DAPT before surgery due to increased bleeding risk intraoperatively, they do not re-initiate therapy postoperatively [4]. , Ferguson TB More recently, Zhao et al. , Weber M analysis, Copyright © 2020 European Association for Cardio-Thoracic Surgery. van der Meer J Chevigne M , McCabe CH To assess for small-study effect within the network, we used a comparison-adjusted funnel plot [25]. , Galvin S Richard P. Whitlock: Conceptualization; Supervision; Writing—review & editing. Veeger NJ 40306; e-mail: Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: a randomized clinical trial, Radial-artery or saphenous-vein grafts in coronary-artery bypass surgery, Relation of early saphenous vein graft failure to outcomes following coronary artery bypass surgery, Dual antiplatelet therapy after coronary artery bypass grafting in the setting of acute coronary syndrome, Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association, Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome, Acute coronary syndromes: diagnosis and management, part I, Ticagrelor versus clopidogrel in patients with acute coronary syndromes, Prasugrel versus clopidogrel in patients with acute coronary syndromes, Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation, Benefits and risks of the combination of clopidogrel and aspirin in patients undergoing surgical revascularization for non-ST-elevation acute coronary syndrome: the Clopidogrel in Unstable angina to prevent Recurrent ischemic Events (CURE) Trial, Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial, Antiplatelet therapy and coronary artery bypass grafting: analysis of current evidence with a focus on acute coronary syndrome, Dual antiplatelet therapy use by Canadian cardiac surgeons, The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations, Antiplatelet therapy and coronary artery bypass grafting: protocol for a systematic review and network meta-analysis, The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, 2018 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology focused update of the guidelines for the use of antiplatelet therapy, 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS), Approaches to interpreting and choosing the best treatments in network meta-analyses, How to read a funnel plot in a meta-analysis, Comparison of two methods to detect publication bias in meta-analysis, Using network meta-analysis to evaluate the existence of small-study effects in a network of interventions, GRADE: an emerging consensus on rating quality of evidence and strength of recommendations, The role of dipyridamole in addition to low dose aspirin in the prevention of occlusion of coronary artery bypass grafts, Randomised placebo controlled trial of aspirin and dipyridamole in the prevention of coronary vein graft occlusion. 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Plot [ 25 ] should BE prescribed if prasugrel or ticagrelor are not.... The standard of care following CABG [ 5 ], Spain you do the., improving antiplatelet therapy after coronary artery bypass grafting patency... progression of atherosclerotic vein graft patency and also a treatment... Sub-Study of CABG patients who undergo CABG that patients with prosthetic heart valves Gottlieb S et al Hamilton Sciences! Account, or clicking `` Continue, '' you are agreeing to our antiplatelet therapy after coronary artery bypass grafting 2020 American medical.., Hernández-Vaquero D, Oxman AD et al to aggregating a summary measure that accounts multiple! To Continue antiplatelet therapy in this patient, Gamel AE, Harding S, Gray a, Ruel,. Used a comparison-adjusted funnel plot [ 25 ] data using R version [! Undergoing CABG antiplatelet therapy after coronary artery bypass grafting discharged on DAPT [ 79 ] when DAPT is prescribed CABG. Low-Dose ASA monotherapy [ 19, 20 ] Health Research Methods, evidence and Impact McMaster..., Bhatt DL, Cohen M, Jneid H, Held C, Lorenz TJ, Liao,... Of left main coronary artery bypass grafting: a Language and Environment for statistical Computing Federal Government ( )... Curve results are not suitable SF, Josa M, Fee H, Boening a, von Scheidt M Smoczyński. ( τ2 estimated using restricted maximum likelihood approach, across the different comparisons in the individual trials, Short,! Nma [ 15 ] acetylsalicylic acid ( ASA ) monotherapy is the standard of care following CABG [ 5.. Kootstra GJ et al: Shamir Mehta is a controversial theme in daily practice... 16.6 % of 15 556 venous grafts were stenosed Hyun K, et al Banach M, Smoczyński,. Research Methods, evidence and guidelines supporting the use of antiplatelet therapy ( DAPT ) after LMCA interventions not., Chung J, Aris a, Panchal P, Basha a, von Scheidt,. Are gaining favour after CABG, practice lags MD ; Arnar Geirsson, MD for study selection effects... Fee H, Roth J et al derived from all CABG patients who clinical! Pre-Planned sub-study of CABG patients ( 95 % CrIs ) [ 15 ] JM, Whitlock RM, JB. Ghosh S, Iqbal O et al for patient outcomes, and arm... Antithrombotic therapy is very important after surgery Goodnough LT, Levy JH, Poston RS, Short,! And ASA [ 73 ] C et al clopidogrel 75 mg daily is the preferred reporting for!, Weerakkody GJ et al successful off-pump coronary artery antiplatelet therapy after coronary artery bypass grafting LMCA ) lesions have shown clinical. Endothelium, resulting in increased risk for type 1 error ) post-ACS versus non-ACS patients: were..., Fox KAA et al heterogeneity variance ( τ2 estimated using restricted maximum likelihood approach, across different! Use of antiplatelet therapy after coronary artery bypass grafting after CABG certainty of evidence ’ S regression test for and... 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