Efficacy and Safety of Dual Antiplatelet Therapy on Graft Patency After Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial

Abstract

<span><strong><em>Background: </em></strong><span>Early vein graft occlusion after coronary artery bypass grafting (CABG) is one of<span> the major problems after the surgery which directly impacts its short- and long-term<span> outcomes. One of the potential explanations is aspirin resistance. The aim of this study<span> was to evaluate the efficacy and safety of dual antiplatelet therapy (DAPT) with<span> clopidogrel and aspirin compared with aspirin alone on the reduction of early graft occ<span> usion.<br /><span><strong><em>Methods: </em></strong><span>In a multicenter randomized controlled trial with a parallel design, from 2012 to 2015<span> among 1165 patients, we compared 140 candidates for CABG: 71 in the DAPT group<span> (300 mg c of clopidogrel and 80–325 mg of aspirin) and 69 in the aspirin group. The<span> primary outcome was graft patency assessed by coronary computed tomography<span> angiography performed at 6 months' follow-up. Bleeding complications were considered<span> the secondary outcome.<br /><span><strong><em>Results: </em></strong><span>Saphenous vein grafts were occluded in 10 (14.1%) patients in the DAPT and 11<span> (15.9%) in the control group (<span><em>P </em><span>= 0.758). After adjustments for study centers, the<span> associations remained unchanged (OR [95% CI]: 1.49 [0.59–3.74]). Bleeding endpoints<span> were also similar in the 2 groups (<span><em>P </em><span>> 0.05).<br /><span><strong><em>Conclusions: </em></strong><span>Our study did not demonstrate the superiority of the DAPT regimen over aspirin<span> monotherapy in patients undergoing elective CABG. Larger multicenter studies may<span> provide more evidence. </span></span></span><br /></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span></span>