Efficacy of Dual Antiplatelet Therapy for Three Months Versus 12 months After Coronary Artery Bypass Grafting: Multicentre, Double Blinded, Randomised Controlled Trial

In this article regarding the outcomes of the timing of platelet inhibition after coronary artery bypass grafting (TOP-CABG trial), the authors tested whether three months of ticagrelor-based dual antiplatelet therapy (DAPT) after elective CABG with ≥1 saphenous vein graft could preserve graft patency while reducing bleeding compared with 12 months of DAPT. Among 2,290 randomized patients, 2,070 underwent one-year graft assessment including 5,125 saphenous vein graft (SVG) segments. SVG occlusion was similar with three vs 12 months of DAPT, at 10.8 percent vs 11.2 percent, meeting the criteria for non-inferiority. Clinically relevant bleeding, defined as Bleeding Academic Research Consortium (BARC) type 2, 3, or 5, was significantly lower with shorter DAPT, 8.3 percent vs 13.2 percent, with a number needed to treat of 21. Major adverse cardiac and cerebrovascular events (MACCE) were also similar, 2.3 percent vs 2.7 percent. Clinically, early DAPT discontinuation after three months may optimize benefit vs bleeding in selected CABG patients.