Antithrombotic strategies for preventing graft failure in coronary artery bypass graft.
Maria Sara MauroSimone FinocchiaroDario CalderoneCarla RochiraFederica AgnelloLorenzo ScaliaDavide CapodannoPublished in: Journal of thrombosis and thrombolysis (2024)
Coronary artery bypass graft (CABG) procedures face challenges related to graft failure, driven by factors such as acute thrombosis, neointimal hyperplasia, and atherosclerotic plaque formation. Despite extensive efforts over four decades, the optimal antithrombotic strategy to prevent graft occlusion while minimizing bleeding risks remains uncertain, relying heavily on expert opinions rather than definitive guidelines. To address this uncertainty, we conducted a review of randomized clinical trials and meta-analyses of antithrombotic therapy for patients with CABG. These studies examined various antithrombotic regimens in CABG such as single antiplatelet therapy (aspirin or P2Y 12 inhibitors), dual antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes including the patency of grafts, major adverse cardiovascular events, and bleeding complications and also explored future perspectives to enhance long-term outcomes for CABG patients. Early studies established aspirin as a key component of antithrombotic pharmacotherapy after CABG. Subsequent randomized controlled trials focused on adding a P2Y 12 inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin, yielding mixed results. This article aims to inform clinical decision-making and guide the selection of antithrombotic strategies after CABG.
Keyphrases
- quality improvement
- percutaneous coronary intervention
- antiplatelet therapy
- coronary artery bypass
- atrial fibrillation
- coronary artery bypass grafting
- coronary artery disease
- st segment elevation myocardial infarction
- cardiovascular events
- st elevation myocardial infarction
- acute coronary syndrome
- meta analyses
- randomized controlled trial
- decision making
- end stage renal disease
- systematic review
- chronic kidney disease
- ejection fraction
- prognostic factors
- adipose tissue
- pulmonary embolism
- squamous cell carcinoma
- liver failure
- radiation therapy
- emergency department
- vascular smooth muscle cells
- hepatitis b virus
- angiotensin ii
- stem cells
- cell therapy
- venous thromboembolism
- patient reported outcomes
- weight loss