BACKGROUND: We assessed the effectiveness of dual antiplatelet therapy (DAPT) post elective or urgent (i.e., post @entity1187 [ @entity1187 ]) coronary artery bypass graft surgery (CABG). METHODS: We systematically searched MEDLINE, EMBASE, and the Cochrane Registry from inception to August 2015. Randomized controlled trials (RCTs) in adults undergoing CABG comparing either dual vs. single antiplatelet therapy or higher- vs. lower-intensity DAPT were identified. RESULTS: Nine RCTs (n   =   4,887) with up to 1y follow-up were included. Five RCTs enrolled @entity1 post-elective CABG (n   =   986). Two multi-centre RCTs enrolled @entity1187 @entity1 who subsequently underwent CABG (n   =   2,155). These 7 RCTs compared @entity1397 plus @entity117 to @entity117 alone. Two other multi-centre RCTs reported on @entity1187 @entity1 who subsequently underwent CABG comparing higher intensity DAPT with either @entity3077 (n   =   1,261) or @entity3076 (n   =   485) plus @entity117 to @entity1397 plus @entity117 . Post-operative anti-platelet therapy was started when chest tube @entity548 was no longer significant, typically within 24-48 h. There were no differences in all-cause mortality in @entity1397 plus @entity117 vs. @entity117 RCTs; conversely, all-cause mortality was significantly lower in @entity3077 and @entity3076 vs. @entity1397 RCTs (risk ratio[RR] 0.49, 95  % confidence interval[CI] 0.33-0.71, p   =   0.0002; 2 RCTs, n   =   1695; I (2)    =   0  %; interaction p   <   0.01 compared to @entity1397 plus @entity117 vs @entity117 RCTs). There were no differences in @entity583 , @entity64 , or composite outcomes. Overall, major @entity548 was not significantly increased (RR 1.31, 95  % CI 0.81-2.10, p   =   0.27; 7 RCTs, n   =   4500). There was heterogeneity (I (2)     =   42  %) due almost entirely to @entity548 reported for the @entity3076 RCT which included mainly CABG-related major @entity548 (RR 3.15, 95 % CI 1.45-6.87, p   =   0.004; 1 RCT, n   =   437). CONCLUSIONS: Most RCT data for DAPT post CABG is derived from subgroups of @entity1187 @entity1 in DAPT RCTs requiring CABG who resume DAPT post-operatively. Limited RCT data with heterogeneous trial designs suggest that higher intensity ( @entity3076 or @entity3077 ) but not lower intensity ( @entity1397 ) DAPT is associated with an approximate 50  % lower mortality in @entity1187 @entity1 who underwent CABG based on post-randomization subsets from single RCTs. Large prospective RCTs evaluating the use of DAPT post-CABG are warranted to provide more definitive guidance for clinicians.

Should dual antiplatelet therapy be used in XXXX following coronary artery bypass surgery? A meta-analysis of randomized controlled trials.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity1187 :: ('MESH:D054058', 'Disease') :: ['ACS', 'acute coronary syndrome'] @entity3076 :: ('MESH:C408153', 'Chemical') :: ['prasugrel'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes'] @entity548 :: ('MESH:D006470', 'Disease') :: ['higher bleeding', 'bleeding'] @entity1397 :: ('MESH:C055162', 'Chemical') :: ['clopidogrel'] @entity117 :: ('MESH:D001241', 'Chemical') :: ['aspirin'] @entity3077 :: ('MESH:C503700', 'Chemical') :: ['ticagrelor'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarctions']
@entity1 :: (9606,Species) :: ['patients']
