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July 10, 2026Journal of Thrombosis and Thrombolysis0 citations

Dual Antiplatelet Therapy With Aspirin and Ticagrelor in ACS Patients Undergoing CABG

Dual antiplatelet therapy with aspirin and ticagrelor vs aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery: a systematic review and meta-analysis

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Why the study?

Does ticagrelor plus aspirin reduce ischemic events or increase bleeding compared to aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery?

Population

Patients with acute coronary syndrome undergoing coronary artery bypass grafting

Comparison

Ticagrelor plus aspirin vs Aspirin alone

Design

Meta-analysis

Key result

Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding without significant differences in myocardial infarction (OR 0.95; 95% CI 0.53-1.72), stroke, or mortality.

Authors

NANajat Y. AlSejariAGAhmed Farid GadelmawlaAAAmal A. Alsubaiei

Discussion

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Overview

Supports aspirin monotherapy after CABG for ACS to reduce bleeding; challenges routine ticagrelor addition in this setting.

Key Points

  • To evaluate the effectiveness and safety of ticagrelor plus aspirin compared to aspirin alone in ACS patients undergoing CABG.
  • Systematic review and meta-analysis of randomized controlled trials and observational studies
  • Comprehensive search of multiple databases including MEDLINE and Cochrane Library
  • Assessment of outcomes like myocardial infarction, ischemic stroke, all-cause mortality, and major bleeding
  • No significant difference in myocardial infarction (OR: 0.95, 95% CI 0.53–1.72) and other ischemic outcomes.
  • Major bleeding significantly increased with ticagrelor plus aspirin versus aspirin alone.
  • Combined analysis indicated ticagrelor plus aspirin associated with lower risk of major adverse cardiovascular events (OR 0.6, 95% CI 0.43–0.83) based on limited studies.

Study Design

Type

Meta-Analysis

Structured PICO

Does ticagrelor plus aspirin reduce ischemic events or increase bleeding compared to aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery?

P
Population
Meta-analysis of 5 studies comparing ticagrelor plus aspirin versus aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass grafting.
I
Intervention
Ticagrelor plus aspirin
C
Comparator
Aspirin alone
O
Outcome
Myocardial infarction (MI), ischemic stroke, all-cause mortality, bleeding, repeat revascularization, graft occlusion, and major adverse cardiovascular events (MACE)hard clinical

In ACS patients undergoing CABG, adding ticagrelor to aspirin significantly increases major bleeding without consistently reducing ischemic or graft-related outcomes.

Main Result

Odds Ratio: 0.95 (95% CI 0.53–1.72)

Limitations

  • Single studies were key sources of heterogeneity for several outcomes.
  • The MACE estimate was based on only two studies and largely driven by one observational cohort.
  • Single studies as key sources of heterogeneity for several outcomes
  • MACE estimate based on only two studies and largely driven by one observational cohort

Cite This Study

AlSejari et al. (2026) conducted a meta-analysis in Acute coronary syndrome (ACS) undergoing coronary artery bypass graft surgery (CABG). Ticagrelor plus aspirin vs. Aspirin alone was evaluated on Myocardial infarction (MI) (OR 0.95, 95% CI 0.53-1.72). Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding without significant differences in myocardial infarction (OR 0.95; 95% CI 0.53-1.72), stroke, or mortality.

synapsesocial.com/papers/6a5090686eeac72a437a186dhttps://doi.org/10.1007/s11239-026-03354-9
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome2025
  2. 2‘Aspirin versus ticagrelor for the management after coronary revascularization - a systematic review and meta‑analysis of randomised trials’2026
  3. 3Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial2018 · 797 citations
  4. 4Efficacy of Ticagrelor Monotherapy in Patients at High Bleeding Risk Undergoing Percutaneous Coronary Intervention: a Systematic Review2025
  5. 5Ticagrelor Versus Clopidogrel in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta‐Analysis2025