Antiplatelet therapy with CABG: chaos in the Netherlands

Excerpt

One of the factors affecting the fate of arterial and venous bypass grafts in coronary artery bypass grafting (CABG) is optimal antithrombotic protection. Traditionally, antiplatelet therapy is the treatment of choice to protect grafts against occlusion [1]. Oral anticoagulants have shown to be effective as well [2], but not superior to antiplatelet agents [3]. Therefore, aspirin has become the standard of care in the prevention of graft occlusion [4]. Nowadays, a complicating factor is the use of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 blocker (clopidogrel, prasugrel or ticagrelor) in patients who have recovered from acute coronary syndromes (ACS) [5, 6]. Not only do they have to undergo CABG for their index ACS, they may already be on DAPT when they become eligible for CABG. These considerations make the choice for antithrombotic protection in patients undergoing CABG complex. …