Timing of Ticagrelor Administration and Graft Failure After Coronary Artery Bypass Surgery

Early graft failure after coronary artery bypass grafting (CABG) occurs in up to 30% of patients,1 primarily due to thrombotic occlusion triggered by endothelial injury during surgical manipulation.2 Dual antiplatelet therapy (DAPT), combining aspirin and an oral P2Y12 inhibitor, has been associated with improved early graft patency, likely by inhibiting platelet activation and thrombus formation.3 The optimal timing for initiating DAPT after CABG, however, remains uncertain. Early initiation may more effectively prevent thrombotic graft occlusion but also increase the risk of postoperative bleeding. Conversely, delayed initiation may reduce bleeding risk but potentially miss a critical window for preventing graft thrombosis. To address this, we examined the association between timing of DAPT initiation and graft failure or bleeding using individual participant data from 4 randomized trials comparing ticagrelor-based DAPT with aspirin monotherapy after CABG.1 The Weill Cornell Medicine Institutional Review Board waived the need for ethics approval, and patient consent was not required (#22–03024559).