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Dual antiplatelet therapy after coronary artery bypass surgery

BMJ 2024; 385 doi: (Published 11 June 2024) Cite this as: BMJ 2024;385:q1083

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Antiplatelet therapy after coronary artery bypass surgery

  1. Sigrid Sandner, associate professor of cardiac surgery1 2
  1. 1Department of Cardiac Surgery, Medical University of Vienna, Austria
  2. 2Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
  1. sigrid.sandner{at}

Dual therapy is linked to lower risk of major cardiovascular events over five years

Antiplatelet therapy is an integral part of secondary prevention for patients with coronary artery disease, as inhibition of platelet aggregation reduces the risk of coronary plaque thrombosis and subsequent cardiovascular events.1 Among patients with coronary artery disease undergoing coronary artery bypass graft surgery, antiplatelet therapy also prevents early saphenous vein graft occlusion.2 The saphenous vein graft is the most common coronary artery bypass graft and is used in more than 90% of procedures in the US owing to its general availability and easy deployment.3 However, graft patency remains suboptimal, with a high risk of occlusion early after surgery which decreases after the first year.2 During surgical manipulation, the graft endothelium incurs mechanical injury and transient ischemia, triggering a platelet driven thrombotic cascade that is responsible for the high early occlusion rates (up to 20% within the first year after surgery).4

Studies conducted several decades ago showed that aspirin at a dose of 100-325 mg once daily significantly decreased the …

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