Hemostasis Today
NewsFeed
Headlines Hematology Health Medicine VTE ASH Plasma Donation
October, 2026
October 2026
M T W T F S S
 1234
567891011
12131415161718
19202122232425
262728293031  
Ney Carter Borges: Where the Benefit Appears in Dual Antiplatelet Therapy
Ney Carter Borges/LinkedIn
May 23, 2026, 07:21

Ney Carter Borges: Where the Benefit Appears in Dual Antiplatelet Therapy

Ney Carter Borges, Member Cardiologist of Global Physician Association at Cleveland Clinic Florida, shared on LinkedIn:

”Dual Antiplatelet Therapy (DAPT): Where the Benefit Appears

The major contemporary question is whether adding a P2Y12 inhibitor (ticagrelor or clopidogrel) to aspirin improves outcomes.

The strongest evidence involves saphenous vein graft (SVG) patency.

A pooled meta-analysis demonstrated:

  • SVG failure with aspirin alone: approximately 20%
  • SVG failure with ticagrelor plus aspirin: approximately 11.2%
  • Relative risk reduction: approximately 49%
  • OR 0.51 (95% CI 0.35–0.74; P < .001)

This means:

  • Approximately 1 graft failure prevented for every 10 patients treated
  • Number Needed to Treat (NNT) ≈ 10

However, this benefit came with increased bleeding:

  • Clinically relevant bleeding nearly tripled
  • BARC 2/3/5 bleeding OR 2.98
  • No major increase in fatal bleeding was observed

CCS vs ACS: Important Clinical Difference

Chronic Coronary Syndromes (Stable CAD)

In stable CABG patients:

  • Aspirin alone remains the default strategy
  • DAPT may be considered in:
    – Low bleeding risk
    – High graft failure risk
    – Complex coronary disease
    – Multiple vein grafts

Evidence for mortality reduction is less robust here.

Acute Coronary Syndromes (ACS)

The evidence becomes much stronger after ACS.

Patients with ACS remain in a prolonged prothrombotic state after surgery.

Meta-analysis data including more than 77,000 CABG patients showed:

DAPT after ACS-CABG reduced:

All-cause mortality:

  • OR 0.42
  • approximately 58% relative reduction

Cardiovascular mortality:

  • Significant reduction
  • Myocardial infarction recurrence:
  • Reduced

But bleeding increased:

Major bleeding:

  • OR 1.44
  • approximately 44% relative increase

Why Ticagrelor and Prasugrel Are Preferred

Compared with clopidogrel:

  • Faster onset
  • More potent platelet inhibition
  • Less variability due to CYP2C19 metabolism

In the PLATO CABG subgroup:

Ticagrelor vs Clopidogrel

All-cause mortality:

  • HR 0.49
  • approximately 51% relative reduction

Cardiovascular mortality:

  • HR 0.52
  • No major increase in surgical bleeding

This is why current ESC guidelines favor ticagrelor or prasugrel after ACS-CABG whenever bleeding risk is acceptable.

Bleeding Risk: The Critical Limiting Factor

The document repeatedly emphasizes that bleeding risk often drives decision-making more than ischemic risk.

High-risk bleeding features include:

  • Advanced age
  • CKD
  • Anemia
  • Female sex
  • Prior bleeding
  • Need for anticoagulation
  • Frailty

The PRECISE-DAPT and WILL-BLEED scores may help estimate risk, although CABG-specific validation remains limited.

Practical Modern Strategy

Stable CABG (CCS)

  • Aspirin lifelong
  • Consider 12 months DAPT only if:
  • Low bleeding risk
  • High graft thrombosis risk

ACS plus CABG

  • DAPT for 12 months is standard
  • Prefer:
  • Ticagrelor plus aspirin
  • Prasugrel plus aspirin
  • Then lifelong aspirin

Final Clinical Perspective

The modern post-CABG approach is no longer ‘one-size-fits-all.”’

Ney Carter Borges: Where the Benefit Appears in Dual Antiplatelet Therapy

Stay updated with Hemostasis Today.

ACS Aspirin CABG CCS clopidogrel DAPT Dual Antiplatelet Therapy Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Ney Carter Borges thrombosis ticagrelor
NewsFeed