13 Patency was assessed for 56 patients (a small sample size), and the authors noted a significant reduction in vein graft disease with the combination of ticagrelor and aspirin (graft occlusion or stenosis: 11.5% vs. performed a placebo-controlled study, randomizing 70 patients to ticagrelor plus aspirin or aspirin alone for 3 months following surgery. 1,12 In the first prospective trial to evaluate the impact of ticagrelor after CABG, Saw et al. 1,2 Moreover, they have shown promising results in recent CAD prevention trials. These newer P2Y12 receptor inhibitors have a more rapid onset of action and lead to greater platelet inhibition compared with clopidogrel. Given the limited benefits noted with postoperative clopidogrel, several trials have been initiated to evaluate ticagrelor and prasugrel after CABG. 10 For the majority of patients who undergo on-pump surgery in the current era, aspirin alone is currently recommended. 10 Importantly, this benefit for dual antiplatelet therapy appeared to be applicable only to patients undergoing off-pump CABG. reported that the addition of clopidogrel to aspirin lowered the risk of vein graft occlusion by 41% (p = 0.02), but at the cost of significantly more major bleeding events, compared with aspirin alone. 11 Summarizing the data on more than 25,000 patients from both randomized and observational studies, Deo et al. Some trials have noted a slight improvement in vein graft patency with the addition of clopidogrel after off-pump CABG, 1,10 but others have found no benefit with postoperative clopidogrel. However, in the cardiac surgery literature, the results have been mixed. 9 Substantial benefits have been demonstrated with the combination of clopidogrel and aspirin in CAD trials. Therefore, several investigators have evaluated the role of other antiplatelet agents following surgery, including clopidogrel, to prevent graft occlusion and slow the progression of native CAD. Nevertheless, even with aspirin-mediated platelet inhibition, saphenous vein graft disease continues to be a clinical challenge in the current era. 8 In the postoperative period, initiating aspirin therapy within 6 hours after CABG helps improve graft patency, prevents adverse cardiovascular events, and improves long-term survival. 1 Aspirin is safe for use when administered prior to surgery, 7 and a recent meta-analysis reported that preoperative aspirin significantly reduces the risk of vein graft occlusion. As such, all CABG patients are candidates for long-term aspirin therapy. In patients with CAD, aspirin reduces the risk of stroke, myocardial infarction, and vascular death. 4-6 The purpose of this analysis is to highlight recent developments in the field of secondary prevention after CABG. However, patient adherence to prescribed medications remains just as important several studies have noted higher event rates among patients with CAD who have poor long-term compliance to medical therapy. For healthcare professionals, administering secondary preventative therapies is a fundamental responsibility following CABG. Other opportunities that exist to improve the long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation. 1 Secondary preventive therapies help maintain long-term graft patency and allow patients to obtain the highest level of physical health and quality of life following CABG.Īs noted in recent guideline statements, 2,3 postoperative antiplatelet agents and lipid-lowering therapies continue to be mainstays of secondary prevention. Secondary preventative therapies, therefore, play an essential role in the management of patients recovering from CABG to slow the disease process and prevent adverse cardiovascular outcomes both in the perioperative period and in the long term. Nevertheless, in the years that follow surgery, CABG patients remain at risk for subsequent ischemic events as a result of native coronary artery disease (CAD) progression and the development of vein graft atherosclerosis. Warzone weapon stats spreadsheet 2022.Coronary artery bypass graft surgery (CABG) is the most complete and durable treatment of ischemic heart disease and has been an established therapy for nearly 50 years.
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