Antiplatelet therapy to prevent saphenous vein graft failure after CABG

  • Solo K & al.
  • BMJ
  • 10 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that dual antiplatelet therapy with either aspirin plus ticagrelor or aspirin plus clopidogrel is more effective than aspirin monotherapy for preventing saphenous vein graft failure after coronary artery bypass graft (CABG) surgery.
  • The risk for major bleeding, myocardial infarction (MI) and death did not differ among the drug interventions.

Why this matters

  • Dual antiplatelet therapy post surgery should be tailored by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.

Study design

  • Meta-analysis of 20 randomised controlled trials including 4803 participants (age, ≥18 years) who received oral antithrombotic drugs to prevent saphenous vein graft failure after CABG was conducted.
  • Primary outcomes: incidence of saphenous vein graft failure and major bleeding.
  • Secondary outcomes: MI and death.
  • Funding: None.

Key results

  • Dual antiplatelet therapy with either aspirin plus ticagrelor (OR, 0.50; 95% CI, 0.31-0.79) or aspirin plus clopidogrel (OR, 0.60; 95% CI, 0.42-0.86) vs aspirin monotherapy was more efficacious to reduce saphenous vein graft failure.
  • There was no strong evidence of differences among different antithrombotic therapies compared with aspirin monotherapy in terms of:
    • Major bleeding:
      • aspirin plus ticagrelor (OR, 1.93; 95% CI, 0.30-12.4; moderate certainty evidence) and
      • aspirin plus clopidogrel (OR, 0.85; 95% CI, 0.30-2.37; low certainty evidence).
    • MI:
      • aspirin plus ticagrelor (OR, 0.70; 95% CI, 0.15-3.22; moderate certainty evidence) and
      • aspirin plus clopidogrel (OR, 0.71; 95% CI, 0.26-1.96; low certainty evidence).
    • All-cause mortality:
      • aspirin plus ticagrelor (OR, 0.70; 95% CI, 0.01-54.3; low certainty evidence) and
      • aspirin plus clopidogrel (OR, 0.70; 95% CI, 0.11-4.50; low certainty evidence).

Limitations

  • Risk of bias.

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