Coronary artery bypass surgery is a common procedure for patients with severe coronary artery disease. The long-term success of the surgery is not just dependent on the procedure but also on the post-surgical management, particularly in terms of antiplatelet therapy.
A five-year follow-up study conducted by researchers examined the effects of different antiplatelet therapies on patients who underwent elective coronary artery bypass grafting (CABG). The trial, referred to as the DACAB trial, involved 500 patients who were randomized into three groups: one receiving dual antiplatelet therapy (ticagrelor plus aspirin), another receiving ticagrelor monotherapy, and the third on aspirin monotherapy.
“Our main goal was to assess which of these therapies would most effectively reduce the risk of major adverse cardiovascular events in the long run,” said the lead researcher, Dr. Qiang Zhao.
The results were telling. At five years, the group treated with dual antiplatelet therapy saw a significantly lower incidence of major adverse cardiovascular events (MACE), compared to those who received aspirin monotherapy or ticagrelor monotherapy. The MACE rate was 22.6% for the dual therapy group, compared to 29.9% for the aspirin group and 32.9% for the ticagrelor group.
“We found that combining ticagrelor with aspirin for one year post-surgery led to fewer events like heart attacks and strokes, which are crucial measures of success in post-surgical recovery,” explained Dr. Zhao. “The reduction in events was maintained even after the first year when treatment was tailored to individual needs.”
The study also evaluated the safety outcomes, including major bleeding risks. While the dual antiplatelet therapy group did have a slightly higher rate of bleeding compared to the ticagrelor group, it was not statistically significant.
Dr. Mario Gaudino, a co-author of the study, added, “The dual therapy approach improves long-term outcomes without a major increase in bleeding risk, making it a viable option for many post-surgical patients.”
The findings suggest that careful management of antiplatelet therapy after CABG can significantly impact patient outcomes. Dual antiplatelet therapy for one year after surgery could become the standard of care for patients at risk of adverse cardiovascular events.
The study also highlighted the importance of individualized care after the first year, with physicians adjusting therapies based on patient progress and risk factors.
“Every patient is different, and while dual therapy shows significant benefits, the decision on long-term management should be made with the patient’s entire clinical picture in mind,” emphasized Dr. Zhao.
This study marks a significant step forward in optimizing post-surgical care for CABG patients, offering insights that may shape future treatment guidelines.
Citation:
Zhu Y, Zhang W, Dimagli A, et al. Antiplatelet therapy after coronary artery bypass surgery: five-year follow-up of randomized DACAB trial. BMJ. 2024;385. doi:10.1136/bmj-2023-075707
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