A Meta-Analysis Comparing Aspirin Alone Versus Dual Antiplatelet Therapy for the Prevention of Venous Graft Failure Following Coronary Artery Bypass Surgery

Hesterberg, Kirstin; Rawal, Aranyak; Khan, Sajjad; Rashid, Abdul; Jones, David; Siddiqui, Tariq; Khader, Thekrayat A. .; Nayyar, Manu; Shah, Rahman

doi:10.1016/j.carrev.2019.10.022

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…Clopidogrel has also been reported to inhibit the process of intimal hyperplasia and smooth muscle hyperplasia in experiments on animal models of thrombus formation. 21 , 22) In view of these reasons, DAPT has been suggested to be more beneficial in preventing SVG occlusion compared to aspirin alone, 23 , 24) which is similar to our theory. In our study, 3 patients (2.9%) in group T and 5 patients (5.4%) in group L were administered DAPT in addition to warfarin.…”

Section: Discussionsupporting

confidence: 77%

Therapeutic-Dose Warfarin (International Normalized Ratio >1.6) Plus Aspirin Improved Long-Term Patency of Saphenous Vein Graft without Bleeding Complication

Tasaki

Arai

Yokoyama

et al. 2022

ATCS

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Purpose: Saphenous vein graft (SVG) is the most commonly used conduits in coronary artery bypass grafting (CABG), but the disadvantage of SVG is its tendency for progressive failure. We hypothesized that therapeutic-dose warfarin (international normalized ratio [INR] >1.6) plus aspirin improve SVG patency. This study aimed to evaluate the factors contributing to SVG patency. Methods: Since 2010–2020, 199 patients who underwent isolated CABG using SVG were divided into two groups according to their INR values in the first year: group T (INR >1.6) and group L (INR <1.6). Results: Group T had 162 SVGs (105 patients) and group L had 151 SVGs (94 patients). The 1-, 4-, and 7-year SVG patency rates were higher in group T than in group L (99%, 96%, and 92% vs. 93%, 86%, and 79%, respectively; p = 0.00378). The 1-, 4-, and 7-year freedom from repeat-revascularization was higher in group T than in group L (100%, 100%, and 99% vs. 98%, 95%, and 87%, respectively; p = 0.0264). Multivariate analysis showed that therapeutic-dose warfarin ( p = 0.00204) and target vessel diameter ( p <0.0001) were independent risk factors of SVG occlusion. Conclusion: Therapeutic-dose warfarin (INR >1.6) plus aspirin after CABG improved the long-term patency of SVG and decreased repeat-revascularization rate.

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Section: Discussionsupporting

confidence: 77%

Therapeutic-Dose Warfarin (International Normalized Ratio >1.6) Plus Aspirin Improved Long-Term Patency of Saphenous Vein Graft without Bleeding Complication

Tasaki

Arai

Yokoyama

et al. 2022

ATCS

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“…DAPT and DPI have never been compared directly and both are reasonable secondary prevention options for patients after CABG who have extensive atherosclerotic disease. Surgeons may prefer to use DAPT over DPI in the first year after CABG in light of meta-analysed data suggesting that DAPT reduces saphenous vein graft failure [27][28][29]. It is also reasonable to choose DPI from the outset given that DPI but not DAPT has been demonstrated to reduce mortality [30].…”

Section: Intensified Antithrombotic Therapymentioning

confidence: 99%

Optimal medical therapy after coronary artery bypass grafting: a primer for surgeons

Eikelboom

Amir²,

Gupta

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewAfter coronary artery bypass grafting (CABG), patients remain at increased risk of cardiovascular events and death. Cardiac surgeons have the opportunity to reduce this risk by optimizing post-CABG patients’ medical therapy.Recent findingsRecent developments in lipid-lowering, diabetes management, antithrombotic therapy, and anti-inflammatory therapy can significantly improve prognosis in patients with chronic coronary artery disease. PCSK-9 inhibitors should be used in patients with elevated LDL cholesterol despite maximally tolerated statin therapy. Icosapent ethyl should be considered in patients with elevated triglycerides despite maximally tolerated statin therapy. Long-acting GLP-1 receptor agonists or SLGT-2 inhibitors should be used in all post-CABG patients with type 2 diabetes. Intensified antithrombotic therapy with DAPT or DPI reduces MACE (and DPI reduces mortality) in patients with high atherosclerotic burden. Colchicine has not yet been incorporated into guidelines on OMT for stable CAD but it is reasonable to consider using it in high-risk patients.SummaryWe review the foundations of optimal medical therapy after CABG, and summarize recent advances with a focus on practical application for the busy cardiac surgeon.

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“…При субоптимальных характеристиках ИУФ и уверенности в отсутствии технических ошибок предполагается форсированная вторичная профилактика тромбоза шунтов с помощью двойной дезагре-гантной терапии. Профилактика окклюзии аутовенозных шунтов путем совместного применения аспирина с тикагрелором или клопидогрелом убедительно показана в ряде исследований [15,16]. Необходимы дальнейшие крупные исследования по вторичной профилактике несостоятельности шунтов после КШ при диффузных поражениях с изучением эффективности антикоагулянтов и дезагрегантов.…”

Section: Discussionunclassified

Intraoperative transit time flow measurement in patients with diffuse coronary artery disease in the prevention of aortocoronary bypass graft occlusion

Акчурин

Shiryaev

Vasiliev

et al. 2021

Cardiovasc Ther Prev

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Aim. To study the parameters of transit time flow measurement (TTFM) for coronary bypass grafts in patients with diffuse lesions with different diameter of target coronary arteries.Material and methods. The study included 150 patients with diffuse coronary artery disease. All patients underwent microscope-assisted coronary artery bypass grafting (CABG), during which the TTFM parameters were evaluated. Depending on the diameter of target coronary arteries, patients were divided into 3 groups: group 1 included grafts to arteries ≤1 mm (n=101), group 2 — 1-1,5 mm (n=138), group 3 — ≥1,5 mm (n=308). Comparative analysis of TTFM parameters was performed.Results. Mostly participants were male (76%); mean age was 62,9±7,6 years. During hospitalization, we recorded 1 death, 2 perioperative myocardial infarctions (1,3%) and 1 cerebrovascular accident (0,7%). TTFM analysis showed the worst hemodynamic parameters and a higher rate of suboptimal function in group 1; blood flow parameters were comparable in groups 2 and 3. The additional analysis in group 1 and combined groups 2 and 3 allows us to make an opinion about the negative impact of coronary artery diameter less than 1 mm on optimal blood flow through the grafts (odds ratio=2,1, 95% confidence interval, 1,2-3,8, p=0,011).Conclusion. Diffuse coronary atherosclerosis with a diameter of target coronary arteries less than 1 mm significantly increase the risk of suboptimal graft function that requires considering more aggressive secondary prevention. TTFM demonstrate high effectiveness of microscope-assisted CABG in target coronary artery diameter of 1-1,5 mm and higher.

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A Meta-Analysis Comparing Aspirin Alone Versus Dual Antiplatelet Therapy for the Prevention of Venous Graft Failure Following Coronary Artery Bypass Surgery

Cited by 9 publications

References 30 publications

Therapeutic-Dose Warfarin (International Normalized Ratio >1.6) Plus Aspirin Improved Long-Term Patency of Saphenous Vein Graft without Bleeding Complication

Therapeutic-Dose Warfarin (International Normalized Ratio >1.6) Plus Aspirin Improved Long-Term Patency of Saphenous Vein Graft without Bleeding Complication

Optimal medical therapy after coronary artery bypass grafting: a primer for surgeons

Intraoperative transit time flow measurement in patients with diffuse coronary artery disease in the prevention of aortocoronary bypass graft occlusion

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