Optimal dual antiplatelet therapy for coronary artery bypass grafting: a systematic review and meta-analysis.

Introduction: This meta-analysis evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) with aspirin combined with ticagrelor, clopidogrel, or prasugrel in coronary artery bypass grafting (CABG) patients.

Methods: Nineteen studies involving 9,585 patients were included.

Results: Post-CABG administration of ticagrelor significantly reduced all-cause mortality (OR = 0.49 [0.33, 0.73]; < 0.01) and minimized major bleeding when discontinued more than 3 days before surgery (OR = 0.62 [0.47, 0.83]; < 0.01). Ticagrelor exhibited a non-significant trend toward reducing both re-bleeding and the need for platelet transfusions. Prasugrel was associated with a higher requirement for platelet transfusions (OR = 1.88; 95% CI: 1.24-2.87; < 0.01). No significant associations were found for myocardial infarction, stroke, or RBC transfusion.

Conclusions: In CABG patients, DAPT with aspirin and ticagrelor offers the best balance between efficacy and safety, improving key outcomes while managing bleeding risk. Prasugrel's increased bleeding risk requires caution in its use.