Home Career Two-Drug Strategy Offers Both Benefits and Risks After Coronary Bypass Surgery –...

Two-Drug Strategy Offers Both Benefits and Risks After Coronary Bypass Surgery – ScienceDaily


A new analysis suggests that a combination of two antiplatelet drugs may benefit patients after the most common type of heart surgery — while increasing the risk of potentially dangerous bleeding. This two-sided finding by researchers at Weill Cornell Medicine and NewYork-Presbyterian suggests that doctors should carefully consider the use of these drugs after this procedure.

In the analysis reported on August 9 YAMA, a team led by Dr. Mario Gaudino, a coronary artery bypass surgeon, studied data from 1,668 transplants in which surgeons use a piece of vein taken from the leg to bypass blocked coronary arteries. Sometimes, however, blood clots form inside the transplanted vein, preventing blood flow. Aspirin is usually given to patients; however, some evidence suggests that aspirin, along with a prescription antiplatelet agent such as ticagrelor, may be more effective in preventing clotting.

“We found that yes, this dual therapy significantly reduces the risk of graft failure. However, we have shown for the first time that this approach also carries a significant risk of clinically important bleeding,” said Dr. Gaudino, the Stephen and Suzanne Weiss Professor of Cardiothoracic Surgery at Weill Cornell Medicine and cardiothoracic surgeons at NewYork-Presbyterian/Weill Cornell Medical Center. “So the benefit comes at a price.”

Taken together, these results suggest that doctors should base their decisions on individual patients’ circumstances and avoid using this approach for those with medical conditions that put them at risk for bleeding, he said.

Each year, approximately 300,000 patients undergo coronary artery bypass grafting to treat narrowed or blocked arteries that deprive the heart muscle of oxygen-rich blood. In more than 90 percent of these procedures, surgeons take a graft from one of the patient’s saphenous veins, which supplies blood to the inside of the legs. However, within a year, a quarter of these transplants become clogged.

Some studies have looked at the benefits of giving patients both aspirin and ticagrelor, an approach known as dual antiplatelet therapy (DAPT). However, these studies have been small and have produced conflicting findings. The team, including first author Dr. Sigrid Sandner, a master’s student in clinical epidemiology at Weill Cornell’s Graduate School of Health Sciences, contacted researchers in four such trials to gain access to their original data. The team then compiled this data, effectively creating a much larger study capable of drawing more definitive conclusions.

They found a failure rate of about 11 percent in patients receiving a combination of aspirin and ticagrelor, while blockages occurred in 20 percent of grafts when patients received aspirin alone. However, compared with aspirin alone, DAPT caused more bleeding that, although not life-threatening, required medical attention.

In these preliminary trials, patients received DAPT for a full year. However, most often graft failure occurs in the first few months after surgery. Next, Dr. Gaudino, who is also the director of a joint clinical trial at Weill Cornell Medicine and NewYork-Presbyterian, hopes to test aspirin and ticagrelor for one to three months to see if a shortened course offers the same benefit with less risk of bleeding.

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Materials is provided Weill Cornell Medicine. Note: Content can be edited for style and length.

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