Two-medication strategy offers both benefit and risk after coronary artery bypass surgery

Medical Xpress / Weill Cornell Medical College / JAMA ^ | August 9, 2022 | Sigrid Sandner et al

[ConservativeMind]

A new analysis shows that a combination of two anti-platelets drugs can benefit patients after the most common type of cardiac surgery—while also increasing the risk of potentially dangerous bleeding. This double-edged finding from investigators suggests physicians should carefully weigh the use of these medications after this procedure.

Dr. Mario Gaudino examined grafts in which surgeons use a piece of vein taken from the leg to circumvent blocked coronary arteries. Sometimes, however, blood clots form within the grafted vein, obstructing blood flow. Typically, patients are given aspirin; however, some evidence suggests that aspirin along with a prescription strength anti-platelet agent, such as one called ticagrelor, can more effectively prevent clotting.

"This dual therapy reduces the risk grafts will fail. However, we have shown that this approach also carries a significant risk of clinically important bleeding," said Dr. Gaudino.

These results indicate physicians should base their decisions on patients' individual circumstances and avoid using this approach for those with conditions that put them at risk of bleeding.

Patients undergo coronary artery bypass grafts 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 carry blood up the inner side of the legs. However, within a year, as many as a quarter of these grafts become obstructed.

Studies have examined giving patients both aspirin and ticagrelor, an approach known as dual antiplatelet therapy (DAPT).

They found a failure rate of approximately 11 percent in patients who received a combination of aspirin and ticagrelor, while blockages occurred in 20 percent of grafts when patients received only aspirin. However, as compared with aspirin alone, DAPT brought on more bleeding events that, while not life threatening, required medical attention.

[ConservativeMind]

It sounds like, in the end, you want the dual therapy, but to be on guard for complications.

Who wants a failed graft?

[ConservativeMind]

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[TexasGator]

Coronary artery disease affects the larger coronary arteries on the surface of the heart. Another type of heart disease, called coronary microvascular disease, affects the tiny arteries in the heart muscle. Coronary microvascular disease is more common in women.

https://www.nhlbi.nih.gov/health/coronary-heart-disease

[Bobalu]

Vortexes and circulating debris....?