Efficacy and Safety of Dual Antiplatelet Therapy on Graft Patency After Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial

Background: Early vein graft occlusion after coronary artery bypass grafting (CABG) is one of the major problems after the surgery which directly impacts its short- and long-term outcomes. One of the potential explanations is aspirin resistance. The aim of this study was to evaluate the efficacy and safety of dual antiplatelet therapy (DAPT) with clopidogrel and aspirin compared with aspirin alone on the reduction of early graft occ usion. Methods: In a multicenter randomized controlled trial with a parallel design, from 2012 to 2015 among 1165 patients, we compared 140 candidates for CABG: 71 in the DAPT group (300 mg c of clopidogrel and 80–325 mg of aspirin) and 69 in the aspirin group. The primary outcome was graft patency assessed by coronary computed tomography angiography performed at 6 months’ follow-up. Bleeding complications were considered the secondary outcome. Results: Saphenous vein grafts were occluded in 10 (14.1%) patients in the DAPT and 11 (15.9%) in the control group (P = 0.758). After adjustments for study centers, the associations remained unchanged (OR [95% CI]: 1.49 [0.59–3.74]). Bleeding endpoints were also similar in the 2 groups (P > 0.05). Conclusions: Our study did not demonstrate the superiority of the DAPT regimen over aspirin monotherapy in patients undergoing elective CABG. Larger multicenter studies may provide more evidence.