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Kulik A, Abreu AM, Boronat V, et al. Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial. J Card Surg. 2021;doi: 10.1111/jocs.16189.
Kulik, A., Abreu, A. M., Boronat, V., Kouchoukos, N. T., & Ruel, M. (2021). Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial. Journal of cardiac surgery, . https://doi.org/10.1111/jocs.16189
Kulik, Alexander, et al. "Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial." Journal of cardiac surgery vol. (2021). doi: https://doi.org/10.1111/jocs.16189
Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial. J Card Surg. 2021 Dec 27; doi: 10.1111/jocs.16189. Epub 2021 Dec 27. PMID: 34961950.
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J Card Surg. 2021 Dec 27; doi: 10.1111/jocs.16189. Epub 2021 Dec 27.

Ticagrelor versus aspirin and vein graft patency after coronary bypass: A randomized trial.

Journal of cardiac surgery

Alexander Kulik, Amy M Abreu, Viviana Boronat, Nicholas T Kouchoukos, Marc Ruel

Affiliations

  1. Division of Cardiac Surgery, Boca Raton Regional Hospital and Florida Atlantic University, Boca Raton, Florida, USA.
  2. Division of Cardiac Surgery, Missouri Baptist Medical Center, St. Louis, Missouri, USA.
  3. Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

PMID: 34961950 DOI: 10.1111/jocs.16189

Abstract

BACKGROUND: Antiplatelet therapy prevents saphenous vein graft (SVG) occlusion and improves outcomes after coronary artery bypass graft surgery (CABG). However, the optimal postoperative antiplatelet regimen remains unclear. The goal of the Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis (TARGET) trial was to assess whether early postoperative ticagrelor reduces SVG occlusion compared to conventional aspirin therapy.

METHODS: In this multi-center double-blind randomized trial, 250 patients who had CABG with SVG were randomized to receive either aspirin 81 mg twice daily or ticagrelor 90 mg twice daily. The primary outcome was SVG occlusion at 1 year.

RESULTS: Altogether, 123 patients were randomized to aspirin and 127 received ticagrelor. One-year graft assessment was performed in 202 patients (80.8%), examining 588 grafts, yielding an overall graft occlusion rate of 10.9%. The primary outcome, SVG occlusion at 1 year, did not significantly differ between the two groups (17.4% vs. 13.2%, aspirin vs. ticagrelor, p = .30). The incidence of vein grafts with any disease (stenosis or occlusion) did not significantly differ between the groups (21.5% vs. 22.3%, aspirin vs. ticagrelor, p = .90), and the number of patients with vein graft disease did not significantly differ between the groups (29.4% vs. 28.0%, aspirin vs. ticagrelor, p = .88). Freedom from major adverse cardiovascular events at 1 year was similar between the groups (p = .60).

CONCLUSIONS: Compared to conventional aspirin therapy, ticagrelor did not significantly reduce vein graft occlusion 1 year after CABG. Further study will assess the impact of ticagrelor on 2-year graft patency for this cohort.

© 2021 Wiley Periodicals LLC.

Keywords: cardiovascular research; coronary artery disease

References

  1. Motwani JG, Topol EJ. Aortocoronary saphenous vein graft disease: pathogenesis, predisposition, and prevention. Circulation. 1998;97(9):916-931. - PubMed
  2. Fitzgibbon GM, Kafka HP, Leach AJ, Keon WJ, Hooper GD, Burton JR. Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years. J Am Coll Cardiol. 1996;28(3):616-626. - PubMed
  3. Kulik A, Ruel M, Jneid H, et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015;131(10):927-964. - PubMed
  4. Kulik A. Secondary prevention after coronary artery bypass graft surgery: a primer. Curr Opin Cardiol. 2016;31(6):635-643. - PubMed
  5. Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71-86. - PubMed
  6. Chesebro JH, Clements IP, Fuster V, et al. A platelet-inhibitor-drug trial in coronary-artery bypass operations: benefit of perioperative dipyridamole and aspirin therapy on early postoperative vein-graft patency. N Engl J Med. 1982;307(2):73-78. - PubMed
  7. Fremes SE, Levinton C, Naylor CD, Chen E, Christakis GT, Goldman BS. Optimal antithrombotic therapy following aortocoronary bypass: a meta-analysis. Eur J Cardiothorac Surg. 1993;7(4):169-180. - PubMed
  8. Bhatt DL, Topol EJ. Antiplatelet and anticoagulant therapy in the secondary prevention of ischemic heart disease. Med Clin N Am. 2000;84(1):163-179. - PubMed
  9. Zimmermann N, Gams E, Hohlfeld T. Aspirin in coronary artery bypass surgery: new aspects of and alternatives for an old antithrombotic agent. Eur J Cardiothorac Surg. 2008;34(1):93-108. - PubMed
  10. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without st-segment elevation. N Engl J Med. 2001;345(7):494-502. - PubMed
  11. Kim DH, Daskalakis C, Silvestry SC, et al. Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2009;138(6):1377-1384. - PubMed
  12. Sørensen R, Abildstrøm SZ, Hansen PR, et al. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction. J Am Coll Cardiol. 2011;57(10):1202-1209. - PubMed
  13. Kulik A, Le May MR, Voisine P, et al. Aspirin plus clopidogrel versus aspirin alone after coronary artery bypass grafting: the clopidogrel after surgery for coronary artery disease (cascade) trial. Circulation. 2010;122(25):2680-2687. - PubMed
  14. Ebrahimi R, Bakaeen FG, Uberoi A, et al. Effect of clopidogrel use post coronary artery bypass surgery on graft patency. Ann Thorac Surg. 2014;97(1):15-21. - PubMed
  15. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045-1057. - PubMed
  16. Held C, Asenblad N, Bassand JP, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the Plato (platelet inhibition and patient outcomes) trial. J Am Coll Cardiol. 2011;57(6):672-684. - PubMed
  17. Kulik A, Abreu AM, Boronat V, Kouchoukos NT, Ruel M. Impact of ticagrelor versus aspirin on graft patency after CABG: rationale and design of the target (ticagrelor antiplatelet therapy to reduce graft events and thrombosis) randomized controlled trial (nct02053909). Contemp Clin Trials. 2018;68:45-51. - PubMed
  18. Alexander JH, Hafley G, Harrington RA, et al. Efficacy and safety of edifoligide, an e2f transcription factor decoy, for prevention of vein graft failure following coronary artery bypass graft surgery: PREVENT IV: a randomized controlled trial. J Am Med Assoc. 2005;294(19):2446-2454. - PubMed
  19. Schunkert H, Boening A, von Scheidt M, et al. Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial. Eur Heart J. 2019;40(29):2432-2440. - PubMed
  20. Saw J, Wong GC, Mayo J, et al. Ticagrelor and aspirin for the prevention of cardiovascular events after coronary artery bypass graft surgery. Heart. 2016;102(10):763-769. - PubMed
  21. Willemsen LM, Janssen PWA, Peper J, et al. Effect of adding ticagrelor to standard aspirin on saphenous vein graft patency in patients undergoing coronary artery bypass grafting (popular CABG): a randomized, double-blind, placebo-controlled trial. Circulation. 2020;142(19):1799-1807. - PubMed
  22. Zhao Q, Zhu Y, Xu Z, et al. Effect of ticagrelor plus aspirin, ticagrelor alone, or aspirin alone on saphenous vein graft patency 1 year after coronary artery bypass grafting: a randomized clinical trial. J Am Med Assoc. 2018;319(16):1677-1686. - PubMed
  23. Kulik A. Commentary: Yin and Yang: antiplatelet and lipid-lowering therapies to prevent vein graft thrombosis and atherosclerosis after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2020. - PubMed

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