ASpirin and Plavix Following Coronary Artery Bypass Grafting (ASAP-CABG): A Randomized, Double-Blind, Placebo-Controlled Pilot Trial

Slim, Ahmad; Fentanes, Emilio; Thomas, Dustin; Slim, Jennifer N.; Triana, Taylor; Ahmadian, Homayoun; McDonough, Ryan; Saucedo, Jason; Suarez, Norma; Pearce-Moore, Dorette; Kirchner, H. Lester; Hulten, Edward; Cury, Ricardo C.; Branch, Kelley

doi:10.9734/bjmmr/2016/24386

Cited by 8 publications

(6 citation statements)

References 30 publications

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“…Our systematic search identified 3266 citations published between 1979 and 2019. Of these, we included 21 articles14 15 16 17 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 that related to 20 unique parallel group randomised controlled trials in the network meta-analysis. These trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo) (fig 1); three trials had three eligible arms and the remaining trials had two eligible arms 16…”

Section: Resultsmentioning

confidence: 99%

“…Eleven randomised controlled trials15 16 17 24 26 31 33 34 35 39 40 comprising 3745 patients reported the incidence of major bleeding. The network diagram of eligible treatment comparisons included eight individual nodes (fig 2, bottom panel).…”

Section: Resultsmentioning

confidence: 99%

“…Ten randomised controlled trials14 15 25 26 29 30 31 33 37 39 comprising 1921 patients reported all cause mortality, and 12 randomised controlled trials14 15 16 17 24 26 31 33 34 35 39 40 comprising 3994 patients reported myocardial infarction. Figure 4 shows networks of treatment comparisons for secondary outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, we judged eight trials (40%)24 25 26 27 28 30 39 40 to have a high risk of bias, primarily owing to failure to blind and missing outcome data. Of trials reporting incomplete outcome data, 10 trials14 15 16 17 27 33 34 35 37 39 performed intention to treat analysis, and two of these16 27 clearly reported the use of intention to treat analysis with worst case assumptions for imputation of missing data. It was unclear how the remaining trials with incomplete data handled missing outcome data.…”

Section: Resultsmentioning

confidence: 99%

“…Because not all the included studies expressed saphenous vein graft failure on a per patient basis, we also included studies that reported per graft data in our base case analysis to increase the totality of evidence. We made the decision about combining per patient and per graft data after we compared the results from per patient14 15 16 25 26 27 28 29 30 31 32 33 34 35 36 37 and per graft14 15 16 17 24 25 26 27 28 29 30 31 32 33 34 35 36 38 39 40 (accounting for clustering effects) meta-analyses. The results for magnitude and direction of effect estimates were consistent and there were large overlapping 95% confidence intervals of effect sizes in most comparisons.…”

Section: Methodsmentioning

confidence: 99%

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Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis

Solo

Lavi

Kabali

et al. 2019

BMJ

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ObjectiveTo assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery.DesignSystematic review and network meta-analysis.Data sourcesMedline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019.Eligibility criteria for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery.Main outcome measuresThe primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death.ResultsThis review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates.ConclusionsThe results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.Study registrationPROSPERO registration number CRD42017065678.

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