Research Shows No Advantage of Dual Antiplatelet Therapy Over Aspirin Alone After Heart Bypass Surgery

Recent clinical research indicates that combining dual antiplatelet therapy with acetylsalicylic acid (aspirin) and ticagrelor does not provide additional benefits for patients undergoing coronary artery bypass surgery compared to aspirin alone. Conducted by researchers at Karolinska Institutet and the University of Gothenburg, the study was published in the New England Journal of Medicine.

The study compared outcomes between two groups of 2,201 patients who had recently undergone cardiac bypass surgery. One group received the standard single therapy with aspirin, while the other received a combination of aspirin and ticagrelor. The average age of participants was 66, with women comprising 14.4%. Patients were followed for 12 months post-surgery.

Key findings revealed no significant difference in the primary composite outcome—which included death, heart attack, stroke, or the need for repeat coronary procedures—between the two groups, with around 5% affected in each. However, a notable difference emerged in bleeding risks: major bleeding incidents occurred in 4.9% of patients on dual therapy, compared to only 2% receiving aspirin alone. This increased bleeding risk suggests that dual therapy may pose unnecessary harm without improving survival or reducing cardiovascular complications.

The researchers emphasize that although longer follow-up is needed, current evidence indicates that the routine use of dual antiplatelet therapy after bypass surgery may not be justified. Dr. Ulrik Sartipy, the study's senior author, highlighted that the findings challenge existing guidelines, advocating for aspirin-only treatment to minimize bleeding risks without compromising safety.

This research prompts a re-evaluation of post-surgical antithrombotic strategies, prioritizing patient safety by avoiding unnecessary use of more aggressive blood-thinning regimens that do not demonstrate clear benefit.