Ticagrelor DAPT Linked to Lower Risk for Vein Graft Failure in CABG

WEDNESDAY, Aug. 17, 2022 — Ticagrelor dual antiplatelet therapy (DAPT) is associated with a reduced risk for saphenous vein graft failure compared with aspirin among patients undergoing coronary artery bypass graft surgery, according to a review published in the Aug. 9 issue of the Journal of the American Medical Association.

Sigrid Sandner, M.D., from the Medical University of Vienna, and colleagues compared the risks for vein graft failure and bleeding associated with ticagrelor DAPT or ticagrelor monotherapy to the risks associated with aspirin among patients undergoing coronary artery bypass graft surgery in a meta-analysis. Four randomized clinical trials were included in the meta-analysis, with 1,316 patients and 1,668 saphenous vein grafts. The primary analysis assessed the incidence of saphenous vein graft failure per graft and included 871 patients: 435 received ticagrelor DAPT and 436 received aspirin.

The researchers found that compared with aspirin, ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure per graft (11.2 versus 20 percent) and with a significantly lower incidence of saphenous vein graft failure per patient (13.2 versus 23.0 percent). A significantly higher incidence of Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events occurred in association with ticagrelor DAPT versus aspirin (22.1 versus 8.7 percent), but not with BARC type 3 or 5 bleeding events (1.8 versus 1.8 percent).

“Ticagrelor DAPT was associated with a significantly lower risk of saphenous vein graft failure and a significantly higher risk of clinically important bleeding events than was aspirin,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including AstraZeneca, the manufacturer of ticagrelor.

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Posted August 2022