Benefit and Safety of Dual Antiplatelet Therapy after Coronary Artery Bypass Grafting for Off-pump CABG: A Systematic Review and Meta-analysis

Abstract

Aims: This study aims to evaluate benefit and safety compared dual antiplatelet therapy with single aspirin therapy after coronary artery bypass grafting. Study Design: A systematic review and Meta-analysis. Place and Duration of Study: Medline, Embase, ScienceDirect and Cochrane Library databases were searched for randomized controlled trials or observational studies focusing on anticoagulant therapy after coronary artery bypass grafting until December 2014. Methodology: Endpoints included postoperative mortality, bleeding events, myocardial infraction, stroke, repeat revascularization and graft occlusion. All these endpoints were compared between dual antiplatelet therapy and single aspirin therapy. Newcastle-Ottawa and Jadal scale were used to assess the quality of observational studies and randomized controlled trials respectively. Software R2.15.2 was utilized for Meta-analysis. Results: 15 studies composed of 31,365 patients were included. Compared with single aspirin Original Research Article Wang et al.; BJMMR, 9(11): 1-15, 2015; Article no.BJMMR.19433 2 therapy, dual antiplatelet therapy resulted in reducing risk of vein graft occlusion (OR=0.53, 95%CI 0.36-0.81, P=0.001), but no significant difference for artery graft occlusion (OR=0.91, 95%CI 0.392.12, P=0.882), Risk of postoperative mortality (OR=0.57, 95%CI 0.38-0.85, P=0.006) and repeat revascularization (OR=0.15, 95%CI 0.05-0.45, P=0.001) was also reduced. There were no significant difference for MI (OR=0.77, 95%CI 0.55-1.09, P=0.137), Stroke (OR=0.85, 95%CI 0.601.19, P=0.330) and bleeding (OR=0.95, 95%CI 0.82-1.09, P=0.465). In subgroup analysis of offpump CABG, dual antiplatelet therapy reduced risk of graft occlusion (OR=0.49, 95%CI 0.30-0.82, P=0.006), MI (OR=0.28, 95%CI 0.11-0.72, P=0.009), mortality (OR=0.39, 95%CI 0.25-0.60, P<0.001), and did not increase risk of bleeding (OR=0.75, 95%CI 0.55-1.02, P=0.066). Conclusions: Dual antiplatelet therapy reduced risk of postoperative graft occlusion and mortality in the early and late postoperative phase after CABG. It appeared to be more beneficial for offpump CABG.