- Question
- Does ticagrelor plus aspirin, or ticagrelor alone, improve saphenous vein graft patency 1 year after coronary artery bypass grafting (CABG) compared with aspirin alone?
- Design
- Randomized 1:1:1, multicenter, open-label trial conducted in 6 tertiary hospitals in China. A total of 500 patients were randomized; the primary outcome was adjudicated by an independent committee blinded to allocation, and follow-up was 1 year.
- Population
- Patients aged 18 to 80 years with an indication for elective CABG. Patients needing urgent revascularization or concomitant cardiac surgery, those requiring dual antiplatelet therapy or vitamin K antagonists after CABG, and those at risk of serious bleeding were excluded.
- Intervention
- Ticagrelor 90 mg twice daily plus aspirin 100 mg daily (n = 168), or ticagrelor 90 mg twice daily alone (n = 166), started within 24 hours after CABG.
- Control
- Aspirin 100 mg once daily (n = 166).
- Primary outcome
- Saphenous vein graft patency 1 year after CABG (FitzGibbon grade A), assessed by multislice computed tomographic angiography or coronary angiography.
- Results
- Graft patency was 88.7% with ticagrelor + aspirin, 82.8% with ticagrelor alone, and 76.5% with aspirin alone. The difference between ticagrelor + aspirin and aspirin alone was 12.2% (95% CI, 5.2% to 19.2%; P < 0.001), whereas ticagrelor alone vs aspirin alone differed by 6.3% (95% CI, -1.1% to 13.7%; P = 0.10).
- Safety
- Five major bleeding episodes occurred during the 1-year follow-up (3 with ticagrelor + aspirin and 2 with ticagrelor alone); the trial was too small to compare bleeding risk between groups.
- Conclusion
- In patients undergoing elective CABG with saphenous vein grafts, ticagrelor plus aspirin significantly increased 1-year graft patency versus aspirin alone, with no significant difference for ticagrelor alone.
- Why it matters
- It provided evidence that intensifying antiplatelet therapy after CABG may improve vein graft patency, fueling debate on postoperative dual antiplatelet therapy and the need for larger trials weighing benefit against bleeding risk.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026