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Kevin Malloy Highlights ESC 2025 Data: TACSI and TOP-CABG Trials Redefine Post-CABG Antiplatelet Therapy
Kevin Malloy/LinkedIn
Sep 12, 2025, 06:43

Kevin Malloy Highlights ESC 2025 Data: TACSI and TOP-CABG Trials Redefine Post-CABG Antiplatelet Therapy

Kevin Malloy, Clinical Pharmacy Specialist at Cleveland Clinic, posted on LinkedIn:

”Post-CABG: to DAPT or not to DAPT?

AHA 2021 Coronary Revascularization Guidelines:
“In selected patients undergoing CABG, DAPT (ticagrelor/clopidogrel + aspirin) for 1 yr may be reasonable to improve vein graft patency compared with aspirin alone (class 2b, LOE B-R)”

Well two hot off the press (conference) trials from ESC 2025 are reshaping our post-CABG antiplatelet strategy:

TACSI Trial

  • Population: n=2,201 *ACS* post-CABG
  • Intervention: ticagrelor + aspirin (12 months, open-label)
  • Comparison: aspirin *mono*therapy (yes, aspirin monotherapy post-ACS)
  • Outcome: *at 1 yr* (10 yr follow-up study ongoing):
    – Thrombotic (MI, stroke, revasc, death): 4.8% vs. 4.6% → HR 1.06 (95% CI: 0.72–1.56)
    – Major bleeding: 4.9% vs. 2.0% → HR 2.50 (95% CI: 1.52–4.11)

But what about the GRAFT?

TOP-CABG Trial
(not yet published)

  • Population: CABG (ACS and SIHD) with 1+ saphenous vein graft, SVG (these guys are more prone to thrombosis)
  • Intervention: De-escalated DAPT (“De-DAPT”), ticagrelor + aspirin → *3 month*→ aspirin monotherapy
  • Comparison: ticagrelor + aspirin (12 months)
  • Outcome:
    – SVG occlusion (1 yr post-CABG, via coronary CT/A) 10.79% in De-DAPT vs 11.19% in DAPT (difference −0.31%; 95% CI: −3.13-2.52, non-inferiority margin +3.5% met ✔️)
    – Bleeding (BARC ≥2): 8.3% vs. 13.2% (HR 0.62; 95% CI: 0.48 to 0.81)

Take-home pearls: Post-CABG Antiplatelet Therapy:

– Aspirin monotherapy is appropriate for most patients after CABG — especially those with SIHD or elevated bleeding risk.

– Even in ACS or SVG grafting, pumping the brakes on DAPT by 3 months is probably the right choice — extended use rarely adds benefit and increases bleeding risk.

Always individualize:
– Assess ischemic vs bleeding risk (PRECISE-DAPT score)
– Account for prior bleeding, GI risk, and consider PPI prophylaxis
– Factor in graft type, clinical context, and patient preferences.”

Stay updated with Hemostasis Today.

Aspirin CABG Cardiology Cleveland Clinic clopidogrel Coronary artery bypass grafting DAPT Dual Antiplatelet Therapy Health Hematology Hemostasis Hemostasis Today Kevin Malloy Medicine TACSI Trial thrombosis ticagrelor TOP-CABG Trial
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