Use of two anti-clotting medications following bypass surgery improves outcomes for grafted veins

Bottom Line: Taking aspirin plus an anti-clotting medication for one year after heart bypass surgery resulted in less narrowing of the vein used to bypass a blocked artery than taking aspirin alone.

Why The Research Is Interesting: Previous data have shown that the rate of failure of a graft of a saphenous vein (a vein from the leg) was approximately 15% to 20% within one year after coronary artery bypass grafting (CABG) surgery and was associated with worse long-term outcomes. Antiplatelet (anti-clotting) therapy with aspirin improves vein graft patency (less narrowing, blockage of the vein). The effect of the anti-clotting drug ticagrelor with or without aspirin on grafted saphenous veins in patients undergoing CABG is unknown.

Who and When: 500 patients who underwent CABG were enrolled in a randomized clinical trial in 2014 and 2015, with final follow-up in early 2017.

What (Study Interventions and Outcomes): Within 24 hours after CABG, 168 patients received ticagrelor (twice daily) and aspirin (once daily); 166 patients received ticagrelor (twice daily); 166 patients received aspirin (once daily) (interventions); patency of the grafted vein (less than 50% narrowing) one year after CABG (outcome)

How (Study Design): This was a randomized clinical trial (RCT). RCTs allow for the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those studied in the RCT.

Authors: Qiang Zhao, M.D., Ph.D., Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China and coauthors

Study Limitations: The trial was designed specifically to examine saphenous vein graft patency so the results cannot be generalized to include arterial grafts. The trial was not equipped to identify a significant effect on the incidence of major adverse cardiac events or other secondary and bleeding outcomes.

More information:
jamanetwork.com/journals/jama/ … .1001/jama.2018.3197

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