ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1542437
Ticagrelor versus clopidogrel in dual antiplatelet therapy after coronary artery bypass surgery: A meta-analysis
Provisionally accepted
Liyuan Wang1
Yingying Zhao1
Shijie Zhang1Tao Zhang1
Jian Song1Yan Yun2Yi Wu2
Zhengjun Wang1*
Xiaochun Ma1*- 1Shandong Provincial Hospital, Jinan, China
- 2Qilu Hospital, Shandong University, Jinan, Shandong Province, China
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Background: Following coronary artery bypass grafting (CABG), the standard treatment regimen typically involves dual antiplatelet therapy (DAPT), which includes a P2Y12 receptor antagonist in combination with aspirin. There is currently no clear consensus regarding the optimal DAPT strategy after CABG. The aim of this meta-analysis was to evaluate and compare the safety and efficacy of ticagrelor versus clopidogrel in patients post-CABG.A meta-analysis of eligible studies of patients undergoing CABG and receiving either aspirin plus clopidogrel (A+C) or aspirin plus ticagrelor (A+T) as antiplatelet therapy, was carried out. The outcomes of interest included all-cause mortality, cardiovascular mortality, major adverse cardiovascular and cerebrovascular events (MACCEs), major bleeding, myocardial infarction, stroke, revascularization, saphenous vein occlusion and total graft occlusion.Results: 4 randomized controlled trials and 3 observational studies (n=2,424) were eligible for final analysis. A+T was associated with a decreased risk of all-cause mortality (OR=0.47, 95% CI 0.31-0.70, p<0.001, p heterogeneity=0.80, I 2 =0%) and cardiovascular mortality (OR=0.50, 95% CI 0.31 to 0.82, p=0.006, p heterogeneity=0.71, I 2 =0%), compared with A+C group. No statistically significant difference was found in the rates of major bleeding (OR=1.16; 95% CI 0.69-1.96; p=0.57; p heterogeneity=0.26; I 2 =23%) between two groups. Besides, the rates of MACCEs, myocardial infarction, stroke, total graft occlusion, revascularization and saphenous vein occlusion were comparable between two groups (p＞0.05).The meta-analysis presented the evidence supporting the use of A+T post-CAVG in reducing all-cause mortality and cardiovascular mortality, with no increase in bleeding events, in comparison with A+C. Additional RCTs are needed to determine the optimal DAPT after CABG.
Keywords: antiplatelet therapy, Coronary Artery Bypass, clopidogrel, ticagrelor, meta analyses
Received: 09 Dec 2024; Accepted: 22 Apr 2025.
Copyright: © 2025 Wang, Zhao, Zhang, Zhang, Song, Yun, Wu, Wang and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhengjun Wang, Shandong Provincial Hospital, Jinan, China
Xiaochun Ma, Shandong Provincial Hospital, Jinan, China
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