Use of 2 anti-clotting medications following bypass surgery improves outcomes for grafted veins

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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.

Related material: The editorial, "Ticagrelor Following Coronary Artery Bypass Grafting," by John H. Alexander, M.D., M.H.S., of Duke University Medical Center, Durham, North Carolina, is also available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2018.3197)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Media Contact

Qiang Zhao, M.D., Ph.D.
[email protected]

@JAMA_current

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