Antithrombotic Therapy in Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review and Network Meta-Analysis
Abstract
Comprehensive evidence on the comparative effects of various oral antithrombotic agents on the prevention of saphenous vein graft failure (SVGF) for patients undergoing coronary artery bypass is lacking. A systematic review and frequentist random-effects network meta-analysis of 18 RCTs (n=3,413 patients) comparing the effect of antithrombotic agents on SVGF and clinical outcomes was performed. Based on moderate quality evidence, among the six eligible interventions, dual-antiplatelet therapy with aspirin and clopidogrel was superior to aspirin monotherapy in reducing SVGF (OR: 0.63; 95% CI: 0.41-0.97). No statistical differences were found for major bleeding, mortality, and myocardial infarction between antithrombotic agents, owing to low number of events for most comparisons. Though significant heterogeneity or incoherence was not found, the quality of network evidence for these outcomes ranged from very low to moderate. Adequately-powered multi-arm RCTs are needed to ascertain the effects of antithrombotic therapies to help clinicians and patients achieve optimal treatment decisions.