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In contrast with twin antiplatelet remedy (DAPT), a de-escalated DAPT technique resulted in related graft occlusion charges and decreased clinically related bleeding in sufferers who underwent coronary artery bypass grafting (CABG), in response to late-breaking analysis offered in a Scorching Line session Sept. 1 at ESC Congress 2025, held in Madrid.
Saphenous vein grafts stay probably the most regularly used conduits in CABG; nonetheless, failure charges are excessive, with 3%–12% occluding earlier than hospital discharge and eight%–25% failing at 1 12 months.
“After CABG, decreased risk of saphenous vein graft failure has been observed with 12 months of DAPT (aspirin plus a P2Y12 inhibitor) but this was accompanied by an increased risk of bleeding,” defined Investigator of the TOP-CABG trial, Physician Xin Yuan from the State Key Laboratory of Cardiovascular Illness, Fuwai Hospital, Nationwide Heart for Cardiovascular Ailments, Beijing, China.
“Quite than receiving DAPT for 12 months, a de-escalated technique of DAPT for 1 or 3 months then aspirin monotherapy for 9 or 11 months is related to related ischemic advantages and higher bleeding security in sufferers after percutaneous coronary intervention (PCI).
Mirroring PCI, the primary 3 months after CABG surgical procedure is a high-thrombotic-risk section, however research of de-escalated DAPT are missing. Thus, we designed the TOP-CABG trial to match the consequences of de-escalated DAPT and DAPT on patency and bleeding occasions for 1 12 months after CABG.”
TOP-CABG trial was a double-blind, parallel-controlled randomized trial performed at 13 hospitals in China. Sufferers older than 18 and youthful than 80 years outdated had been recruited in the event that they had been present process deliberate CABG for the primary time with a minimum of one saphenous vein graft. Sufferers had been randomized 1:1 to de-escalated DAPT (ticagrelor 90 mg twice every day plus aspirin 100 mg as soon as every day for 3 months, then placebo twice every day plus aspirin 100 mg as soon as every day for 9 months) or to DAPT (ticagrelor 90 mg twice every day plus aspirin 100 mg as soon as every day for 1 12 months).
The first noninferior efficacy endpoint was 100% occlusion of the saphenous vein graft inside 1 12 months after CABG on the per-graft stage, with occlusion assessed by coronary computed tomography angiography or coronary angiography. The prespecified noninferiority margin was 3.5%. The first superior security endpoint was clinically related bleeding on the per-patient stage (Bleeding Tutorial Analysis Consortium [BARC] classification ≥2) inside 1 12 months.
The two,290 sufferers included had a imply age of 61.5 years and 20.6% had been feminine.
Noninferiority was demonstrated for the first efficacy endpoint of graft occlusion, which occurred in 10.79% of sufferers’ grafts within the de-escalated DAPT group and 11.19% within the DAPT group (distinction −0.31%; 95% confidence interval [CI] −3.13 to 2.52; p=0.008). The first security endpoint of clinically related bleeding was much less frequent with de-escalated DAPT vs. DAPT (8.26% vs. 13.19% of sufferers; HR 0.62; 95% CI 0.48 to 0.81; p
There was no distinction between the teams for secondary outcomes together with graft failure, any graft stenosis, any graft occlusion or main opposed cardiac and cerebrovascular occasions.
Physician Yuan concluded, “In the largest CABG trial to date, a de-escalation strategy offered a better balance between graft patency protection and bleeding risk than DAPT. These findings may help to inform future guidelines regarding the benefits of a shorter period of DAPT during the early phase after CABG.”
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European Society of Cardiology
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De-escalation of twin antiplatelet remedy gives advantages in sufferers after coronary artery bypass grafting (2025, September 5)
retrieved 6 September 2025
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