Ticagrelor and aspiring dual antiplatelet therapy is favourable over monotherapy following coronary artery bypass

1. Dual antiplatelet therapy with ticagrelor and asprin led to a significantly lower risk of major adverse cardiovascular events over 5 years compared to ticagrelor or asprin monotherapy

2. Bleeding and other adverse events were similar between dual antiplatelet, ticagrelor monotherapy, and asprin monotherapy 

Evidence Rating Level: 1 (Excellent)

Typically, asprin monotherapy is recommended after a coronary artery bypass graft surgery to reduce the risk of adverse cardiovascular events and improve graft patency. Dual antiplatelet therapy (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily) is currently limited to patients with high ischemic risk. This trial looked to compare ticagrelor dual antiplatelet therapy, ticagrelor monotherapy and asprin monotherapy 5 years after coronary artery bypass grafting. The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularization). A safety outcome was also analyzed post hoc and included major bleeding events, and serious adverse events resulting in hospitalization or emergency department visits. Dual antiplatelet therapy (22.6%) resulted in significantly lower risk of major adverse cardiovascular events compared to asprin (29.9%) or ticagrelor monotherapy (32.9%). No difference was seen between asprin or ticagrelor monotherapy. Patients who received dual antiplatelet therapy in the first year and then switched to aspirin monotherapy had significantly lower risk of major adverse cardiovascular events compared to patients only treated with asprin monotherapy. Major bleeding events were not significantly different between any of the groups. A key limitation is that 82% of the participants were male making the generalizability of this study lower.

Click to read the study in BMJ

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