Different antithrombotic strategies after coronary artery bypass grafting to prevent adverse events

Abstract BackgroundTo evaluate the relationship between different postoperative antithrombotic strategies and in-hospital adverse events in patients undergoing isolated coronary artery bypass grafting surgery.MethodsData were extracted from the Medical Information Mart for Intensive Care III database. Patients undergoing isolated coronary artery bypass grafting surgery due to coronary artery disease were divided into the ASA (aspirin only) or DAPT (aspirin plus clopidogrel) group according to the antiplatelet strategy. Patients were also stratified into subgroups based on the type of anticoagulation. The risk of bleeding and adverse events was investigated and compared between groups. ResultsA total of 3274 patients were included in this study, with 2385 in the ASA group and 889 in the DAPT group. No significant difference was seen in the risk of major bleeding between the two groups according to the PLATO, TIMI or GUSTO criteria. There was no difference in the postoperative mortality. In subgroup analysis, patients given anticoagulant therapy had an increased incidence of bleeding-related events. Multivariable analysis revealed that postoperative anticoagulant therapy and the early use of heparin, but not dual antiplatelet therapy, were independent predictors of bleeding-related events.ConclusionsPostoperative dual antiplatelet therapy was not associated with an increased occurrence of bleeding-related events in patients undergoing isolated coronary artery bypass grafting surgery and appears to be a safe antiplatelet therapy. The addition of anticoagulants to antiplatelet therapy increased the risk of bleeding and should be considered cautiously in clinical practice.