Should dual antiplatelet therapy be used in patients following coronary artery bypass surgery? A meta-analysis of randomized controlled trials.

ABSTRACT: We assessed the effectiveness of dual antiplatelet therapy (DAPT) post elective or urgent (i.e., post acute coronary syndrome [ACS]) coronary artery bypass graft surgery (CABG).We systematically searched MEDLINE, EMBASE, and the Cochrane Registry from inception to August 2015. Randomized controlled trials (RCTs) in adults undergoing CABG comparing either dual vs. single antiplatelet therapy or higher- vs. lower-intensity DAPT were identified.Nine RCTs (n?=?4,887) with up to 1y follow-up were included. Five RCTs enrolled patients post-elective CABG (n?=?986). Two multi-centre RCTs enrolled ACS patients who subsequently underwent CABG (n?=?2,155). These 7 RCTs compared clopidogrel plus aspirin to aspirin alone. Two other multi-centre RCTs reported on ACS patients who subsequently underwent CABG comparing higher intensity DAPT with either ticagrelor (n?=?1,261) or prasugrel (n?=?485) plus aspirin to clopidogrel plus aspirin. Post-operative anti-platelet therapy was started when chest tube bleeding was no longer significant, typically within 24-48 h. There were no differences in all-cause mortality in clopidogrel plus aspirin vs. aspirin RCTs; conversely, all-cause mortality was significantly lower in ticagrelor and prasugrel vs. clopidogrel RCTs (risk ratio[RR] 0.49, 95% confidence interval[CI] 0.33-0.71, p?=?0.0002; 2 RCTs, n?=?1695; I(2) ?=?0%; interaction p?

SUBMITTER: Verma S 

PROVIDER: S-EPMC4605093 | biostudies-other | 2015 Oct

REPOSITORIES: biostudies-other