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The Journal of Cardiovascular Surgery 2020 October;61(5):662-72

DOI: 10.23736/S0021-9509.20.11306-5


language: English

Early dual antiplatelet therapy versus aspirin monotherapy after coronary artery bypass surgery: survival and safety outcomes

João N. ROCHA-GOMES 1, Francisca A. SARAIVA 1, Rui J. CERQUEIRA 1, 2, Raquel MOREIRA 1, Ana F. FERREIRA 1, António S. BARROS 1, Mário J. AMORIM 1, 2, Paulo PINHO 1, 2, André P. LOURENÇO 1, 3, Adelino F. LEITE-MOREIRA 1, 2

1 Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal; 2 Department of Cardiothoracic Surgery, São João University Hospital, Porto, Portugal; 3 Department of Anesthesiology, São João University Hospital, Porto, Portugal

BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG.
METHODS: Single-center retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Survival analysis (median follow-up 9 years) was performed using Kaplan-Meier curves and multivariable Cox regression using propensity score (PS) as a covariate along with DAPT. Bleeding was assessed through red blood cells’ (RBC) transfusion, re-exploration of thorax and drainage.
RESULTS: We included 351 patients (251 were DAPT). Kaplan-Meier curves showed similar cumulative survival between groups (9y: 75% DAPT vs. 67% ASA, Log-rank P=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95% CI: 0.57-1.51). We found no differences in early mortality (2 DAPT and 1 ASA). Total median cell-saver transfusion (300 mL vs. 250 mL) and the re-exploration of thorax due to bleeding (1.6% vs. 4%) showed no statistical significance either. On the other hand, postoperative total median chest tube drainage was higher in the ASA group (1220 mL DAPT vs. 1320 mL ASA, P=0.034). There was also a lower frequency of DAPT patients requiring RBC transfusions (≥3 units 4.8% vs. 13%, P=0.009, respectively). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up.
CONCLUSIONS: Compared with ASA, DAPT showed a non-significant impact on long-term survival and demonstrated to be a safe option. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.

KEY WORDS: Coronary artery disease; Coronary artery bypass; Aspirin; Clopidogrel; Survival

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