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<p>The role of dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin after coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) remains uncertain. We performed a systematic review and meta-analysis to compare ticagrelor plus aspirin versus aspirin alone in ACS patients undergoing CABG. We performed a comprehensive search of MEDLINE, Cochrane Library, Scopus, and Web of Science for studies that compared ticagrelor plus aspirin to aspirin alone in patients with ACS undergoing CABG. The main meta-analysis was restricted to randomized controlled trials, while observational evidence was incorporated only in exploratory analyses. Outcomes including myocardial infarction (MI), ischemic stroke, all-cause mortality, bleeding, repeat revascularization, graft occlusion, and major adverse cardiovascular events (MACE) were analyzed. Risk of bias was assessed using Rob-2 for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. GRADE was used to assess the certainty of the evidence. Seven articles representing five studies were included. There were no significant differences in myocardial infarction (MI) (OR: 0.95, 95% CI 0.53–1.72), ischemic stroke, all-cause mortality, while a significant increase in major bleeding was observed. No difference was also found in repeat revascularization, graft occlusion, or minor bleeding. Sensitivity analyses identified single studies as key sources of heterogeneity for several outcomes. In the combined analysis including randomized and observational evidence, ticagrelor plus aspirin showed a lower risk of study-defined MACE compared with aspirin alone (OR 0.6, 95% CI 0.43–0.83) although this estimate was based on only two studies and was largely driven by one observational cohort. Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding, while other ischemic, graft-related, and minor bleeding outcomes showed no consistent significant differences. Further high-quality randomized evidence is needed to clarify the net clinical benefit of this strategy.</p> Graphical Abstract <p></p>

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Dual antiplatelet therapy with aspirin and ticagrelor vs aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年7月8日

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  • Najat Y. AlSejari,
  • Ahmed Farid Gadelmawla,
  • Amal A. Alsubaiei,
  • Asayel M. Alsultan,
  • Abdulrahman N. Alawadhi,
  • Ali Alwazzan,
  • Mahdi Abdulhadi Alwazzan,
  • Mooza Isa Alkubaisi,
  • Danah AlSafy,
  • Rataj Naser Alattar,
  • Abdulaziz Saud Alzeaby,
  • Hamidah Abdulhadi Alwazzan,
  • Estabraq Alaskari,
  • Esra Abdullah AlMadsari,
  • Abdullah M. Alharran

摘要

The role of dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin after coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) remains uncertain. We performed a systematic review and meta-analysis to compare ticagrelor plus aspirin versus aspirin alone in ACS patients undergoing CABG. We performed a comprehensive search of MEDLINE, Cochrane Library, Scopus, and Web of Science for studies that compared ticagrelor plus aspirin to aspirin alone in patients with ACS undergoing CABG. The main meta-analysis was restricted to randomized controlled trials, while observational evidence was incorporated only in exploratory analyses. Outcomes including myocardial infarction (MI), ischemic stroke, all-cause mortality, bleeding, repeat revascularization, graft occlusion, and major adverse cardiovascular events (MACE) were analyzed. Risk of bias was assessed using Rob-2 for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. GRADE was used to assess the certainty of the evidence. Seven articles representing five studies were included. There were no significant differences in myocardial infarction (MI) (OR: 0.95, 95% CI 0.53–1.72), ischemic stroke, all-cause mortality, while a significant increase in major bleeding was observed. No difference was also found in repeat revascularization, graft occlusion, or minor bleeding. Sensitivity analyses identified single studies as key sources of heterogeneity for several outcomes. In the combined analysis including randomized and observational evidence, ticagrelor plus aspirin showed a lower risk of study-defined MACE compared with aspirin alone (OR 0.6, 95% CI 0.43–0.83) although this estimate was based on only two studies and was largely driven by one observational cohort. Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding, while other ischemic, graft-related, and minor bleeding outcomes showed no consistent significant differences. Further high-quality randomized evidence is needed to clarify the net clinical benefit of this strategy.

Graphical Abstract