DAPT with ticagrelor and aspirin combo reduces saphenous vein graft failure in CABG: JAMA

Recent research published in the JAMA Network found that Ticagrelor added to Aspirin was associated with a significantly decreased risk of vein graft failure in patients undergoing coronary artery bypass graft surgery. 

In patients undergoing coronary artery bypass graft, the role of Ticagrelor antiplatelet therapy with or without Aspirin is uncertain. So, researchers conducted a systematic review and meta-analysis to compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery. 

Researchers collected the randomized clinical trials (RCTs) comparing the effects of ticagrelor DAPT or ticagrelor monotherapy vs aspirin on saphenous vein graft failure from databases like MEDLINE, Embase, and Cochrane Library from inception to June 1, 2022, without language restriction. Each trial's patient data were combined into a single data set for an independent analysis. Multilevel logistic regression models were used. The primary analysis looked at the incidence of saphenous vein graft failure per graft from the RCTs comparing ticagrelor DAPT with aspirin. This is the primary outcome of the measurement. Saphenous vein graft failure per patient and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events were the Secondary outcomes of measurement. RCTs comparing ticagrelor monotherapy to aspirin were included in the supplementary analysis. 

Results:

• A total of 4 RCTs were included in the meta-analysis, involving 1316 patients and 1668 saphenous vein grafts.
• Of the 871 patients in the primary analysis, 435 received ticagrelor DAPT and 436 received aspirin.
• There were 65 women and 370 men among the 435 patients who received ticagrelor DAPT with a median age of 67 years. 
• There were 63 women and 373 men among the 436 patients who received aspirin with median age, of 66 years.
• Ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure (11.2%) per graft than was aspirin and was associated with a significantly lower incidence of saphenous vein graft failure per patient.
• Ticagrelor DAPT (22.1%) was associated with a significantly higher incidence of BARC type 2, 3, or 5 bleeding events than was aspirin, but not BARC type 3 or 5 bleeding events.
• Compared with aspirin, ticagrelor monotherapy was not significantly associated with saphenous vein graft failure or BARC type 2, 3, or 5 bleeding events. 

Thus, the researchers concluded that ticagrelor with aspirin was associated with a significantly decreased risk of vein graft failure among patients undergoing coronary artery bypass graft surgery. They also suggested that this was associated with a significantly increased risk of clinically important bleeding. 

For the full article, click here: 10.1001/jama.2022.11966 

Sandner S, Redfors B, Angiolillo DJ, et al. Association of Dual Antiplatelet Therapy With Ticagrelor With Vein Graft Failure After Coronary Artery Bypass Graft Surgery: A Systematic Review and Meta-analysis. JAMA. 2022;328(6):554-562.