Treatment with dual antiplatelet therapy (DAPT) for 3 months is as good as the 12-month DAPT strategy in saphenous vein graft (SVG) occlusion but is more efficacious in reducing the risk of bleeding among patients undergoing elective coronary artery bypass grafting (CABG), a study has shown.
“Among patients undergoing elective CABG with SVG, a 3-month DAPT strategy had similar 1-year rates of SVG occlusion while statistically significantly reducing bleeding risk compared with a 12-month DAPT strategy,” the investigators said.
Some 2,290 patients (mean age 61.5 years, 20.6 percent women) were included in the modified intention-to-treat analysis, with a mean number of 2.5 SVG segments. Of these, 2,070 (90.4 percent) with a total of 5,125 SVG segments were assessed at 1 year. [BMJ 2026;393:e088939]
The rate of SVG occlusion did not significantly differ between the 3-month and 12-month DAPT groups (10.8 percent vs 11.2 percent; absolute difference, ‒0.31 percent, 95 percent confidence interval [CI], ‒3.13 to 2.52; p=0.008 for noninferiority).
Over a median follow-up of 368 days, fewer Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding occurred in the 3-month vs the 12-month DAPT group (95 vs 149 patients; 8.3 percent vs 13.2 percent; absolute difference, ‒4.67 percent, 95 percent CI, ‒7.18 to ‒2.16; p<0.001). The number needed to treat to prevent a single bleeding event was 21 (95 percent CI, 13‒46).
Major adverse cardiovascular events (MACCE) were also similar between the two treatment strategies (2.3 percent vs 2.7 percent; absolute difference, ‒0.11 percent, 95 percent CI, ‒1.48 to 1.26). Likewise, the findings for other outcomes, including SVG failure, venous or arterial graft stenosis, and venous or arterial graft occlusion, did not significantly differ between groups.
Shorter DAPT duration
“The rationale for shorter duration of DAPT is supported by the temporal dynamics of platelet activation and graft healing: postoperative platelet hyperactivity peaks in the first few months after CABG, and re-endothelialization is largely completed by this time,” the investigators said. [Nat Rev Cardiol 2016;13:451-470; Platelets 2019;30:975-981; Circulation 2017;136:1749-1764]
Two previous trials have demonstrated stable or similar SVG occlusion rates at 3 months and 12 months (PATENCY) and at 1 and 2 years (TARGET), suggesting that continued antiplatelet therapy beyond the early postoperative period may not be necessary to reduce SVG occlusion and increase bleeding risk. [BMJ 2025;389:e082883; J Card Surg 2022;37:1969-1977; J Card Surg 2022;37:1978-1979]
“In addition, the timing of DAPT initiation is another key aspect of post-surgical care,” the investigators said. “Although our study did not compare initiation windows, further study is needed to investigate the optimal timing.”
The current multicentre, noninferiority, double-blind, randomized controlled trial was conducted in 13 cardiac surgery centres in China, with enrolment between February 2023 and July 2024. Participants were randomly allocated to receive DAPT (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily) for 12 months or for the first 3 months, followed by placebo plus aspirin for 9 months.
SVG occlusion at 1 year (noninferiority) and BARC type 2, 3, or 5 bleeding (superiority) were the primary outcomes, while MACCE, SVG graft failure, venous or arterial graft stenosis, and venous or arterial graft occlusion were secondary.
“Future studies should focus on long-term outcomes and their comparison with alternative P2Y12-based regimens,” the investigators said.