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

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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
Volume121
Issue number1
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Coronary Artery Bypass
Aspirin
Meta-Analysis
Odds Ratio
Confidence Intervals
Acute Coronary Syndrome
Observational Studies
Hemorrhage
Transplants
Mortality
Therapeutics
Standard of Care
Randomized Controlled Trials
Stroke
Myocardial Infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Agarwal, N., Mahmoud, A. N., Patel, N. K., Jain, A., Garg, J., Mojadidi, M. K., ... Bhatt, D. L. (2018). Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting. American Journal of Cardiology, 121(1), 32-40. https://doi.org/10.1016/j.amjcard.2017.09.022

Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting. / Agarwal, Nayan; Mahmoud, Ahmed N.; Patel, Nimesh Kirit; Jain, Ankur; Garg, Jalaj; Mojadidi, Mohammad Khalid; Agrawal, Sahil; Qamar, Arman; Golwala, Harsh; Gupta, Tanush; Bhatia, Nirmanmoh; Anderson, R. David; Bhatt, Deepak L.

In: American Journal of Cardiology, Vol. 121, No. 1, 01.01.2018, p. 32-40.

Research output: Contribution to journalArticle

Agarwal, N, Mahmoud, AN, Patel, NK, Jain, A, Garg, J, Mojadidi, MK, Agrawal, S, Qamar, A, Golwala, H, Gupta, T, Bhatia, N, Anderson, RD & Bhatt, DL 2018, 'Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting', American Journal of Cardiology, vol. 121, no. 1, pp. 32-40. https://doi.org/10.1016/j.amjcard.2017.09.022
Agarwal, Nayan ; Mahmoud, Ahmed N. ; Patel, Nimesh Kirit ; Jain, Ankur ; Garg, Jalaj ; Mojadidi, Mohammad Khalid ; Agrawal, Sahil ; Qamar, Arman ; Golwala, Harsh ; Gupta, Tanush ; Bhatia, Nirmanmoh ; Anderson, R. David ; Bhatt, Deepak L. / Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting. In: American Journal of Cardiology. 2018 ; Vol. 121, No. 1. pp. 32-40.
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