Benefits of Shortened Dual Antiplatelet Therapy After Coronary Bypass Surgery

Recent research presented at ESC Congress 2025 highlights that a de-escalated approach to dual antiplatelet therapy (DAPT) after coronary artery bypass grafting (CABG) can provide significant advantages. The study compared a shorter DAPT regimen—three months of ticagrelor plus aspirin followed by aspirin alone—to the traditional 12-month DAPT, which combines ticagrelor and aspirin throughout. The findings showed that the de-escalated strategy maintained similar graft patency rates, with occlusion observed in approximately 11% of grafts in both groups. Importantly, patients on the shorter DAPT protocol experienced a notably reduced incidence of bleeding complications, 8.26% compared to 13.19% in the standard DAPT group.

Saphenous vein graft failure remains a concern post-CABG, with high failure rates reported within the first year. While longer DAPT has been linked to improved graft durability, it also increases bleeding risks. The TOP-CABG trial, a large, randomized, double-blind study involving over 2,200 patients across China, demonstrated that limiting DAPT to three months followed by aspirin alone offers a balanced benefit—preserving graft patency while minimizing bleeding hazards.

The trial's primary outcomes confirmed non-inferiority regarding graft occlusion rates, and safety profiles favored the de-escalated DAPT strategy. These results suggest that a shorter course of DAPT could become a new standard to optimize outcomes in post-CABG management, aligning with strategies used in percutaneous coronary interventions. As research advances, clinicians may adopt this approach to improve patient safety and long-term graft success.