Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting

Nayan Agarwal, Ahmed N. Mahmoud, Nimesh Kirit Patel, Ankur Jain, Jalaj Garg, Mohammad Khalid Mojadidi, Sahil Agrawal, Arman Qamar, Harsh Golwala, Tanush Gupta, Nirmanmoh Bhatia, R. David Anderson, Deepak L. Bhatt

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24 Scopus citations


Although aspirin monotherapy is considered the standard of care after coronary artery bypass grafting (CABG), more recent evidence has suggested a benefit with dual antiplatelet therapy (DAPT) after CABG. We performed a meta-analysis of observational studies and randomized controlled trials comparing outcomes of aspirin monotherapy with DAPT in patients after CABG. Subgroup analyses were conducted according to surgical technique (i.e., on vs off pump) and clinical presentation (acute coronary syndrome vs no acute coronary syndrome). Random effects overall risk ratios (RR) were calculated using the DerSimonian and Laird model. Eight randomized control trials and 9 observational studies with a total of 11,135 patients were included. At a mean follow-up of 23 months, major adverse cardiac events (10.3% vs 12.1%, RR 0.84, confidence interval [CI] 0.71 to 0.99), all-cause mortality (5.7% vs 7.0%, RR 0.67, CI 0.48 to 0.94), and graft occlusion (11.3% vs 14.2%, RR 0.79, CI 0.63 to 0.98) were less with DAPT than with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. In conclusion, DAPT appears to be associated with a reduction in graft occlusion, major adverse cardiac events, and all-cause mortality, without significantly increasing major bleeding compared with aspirin monotherapy in patients undergoing CABG.

Original languageEnglish (US)
Pages (from-to)32-40
Number of pages9
JournalAmerican Journal of Cardiology
Issue number1
StatePublished - Jan 1 2018
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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