Dual antiplatelet therapy after CABG linked to a key benefit—and a key risk
After coronary artery bypass graft (CABG) surgery, a regimen of ticagrelor plus aspirin significantly reduced patients’ risk of vein graft failure compared to aspirin alone, according to a new meta-analysis published in JAMA.[1] However, the combined ‘dual therapy’ also increased the risk of a potentially dangerous bleeding event.
Approximately 11% of CABG patients who took both ticagrelor and aspirin experienced vein graft failure, compared with 20% of patients who took aspirin alone, according to the review. Yet 22.1% of the dual therapy patients experienced significant bleeding events (categorized as types 2, 3, or 5 according to the Bleeding Academic Research Consortium scale), compared to just 8.7% of the aspirin-only patients.
“We found that, yes, this dual therapy significantly reduces the risk that the grafts will fail. However, for the first time, we have shown that this approach also carries a significant risk of clinically important bleeding,” Gaudino, a professor of cardiothoracic surgery at Weill Cornell Medicine and a cardiothoracic surgeon at NewYork-Presbyterian/Weill Cornell Medical Center, said in a statement about the review. “So, the benefit comes at a price.”
The four smaller-scale studies included in the team's meta-analysis had originally reached conflicting conclusions. By compiling, combining, and analyzing the raw data from all four studies as part of their review, the authors offer a more comprehensive and decisive answer for patients and physicians seeking guidance.