| Summary: | BACKGROUNDː There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. METHODSː Single-centre retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Survival analysis (median follow-up 9 years) was performed using Kaplan-Meier curves and multivariable Cox regression using propensity score (PS) as a covariate along with DAPT. Bleeding was assessed through red blood cells' (RBC) transfusion, re-exploration of thorax and drainage. RESULTSː We included 351 patients, and DAPT was performed in 251 patients (71.5%). Kaplan-Meier curves showed similar cumulative survival between groups (9y: 75% DAPT vs. 67% ASA, Log-rank p=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95%CI:0.57-1.51). Regarding safety outcomes, we found no differences in early mortality (2 in the DAPT group, 1 in the ASA group). Total median cell-saver transfusion (300mL vs. 250mL, p=0.318) and the re-exploration of thorax due to bleeding (1.6% vs. 4%, p=0.231) showed no statistical significance either. On the other hand, post-operative total median chest tube drainage was higher in the ASA group (1220mL DAPT vs. 1300mL ASA, p=0.043). There was also a lower frequency of DAPT patients requiring ≥3 peri and postoperative RBC transfusions (8.5% vs. 13.3% p<0.001 and 4.8% vs.13%, p=0.009, respectively) and a shorter in-hospital stay following CABG for DAPT (median of 7 days vs. 8 days for ASA, p<0.001). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up. CONCLUSIONSː Compared with ASA, DAPT showed a non-significant impact on long-term survival and demonstrated to be a safe option within the assessed bleeding outcomes. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.
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