Is administration of dual-antiplatelet therapy beneficial for patients following off-pump coronary artery bypass grafting?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether administration of dual-antiplatelet therapy (DAPT) following off-pump coronary artery bypass grafting (OPCAB) would improve postoperative clinical outcomes or minimize the incidence of postoperative graft failure. In total, 101 papers were found using the reported search, 14 of which represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. One meta-analysis and 3 randomized controlled trials showed that DAPT following OPCAB is associated with decreased incidence of saphenous vein graft occlusion. One randomized controlled trial and 4 observational studies showed no effect of DAPT on mortality following OPCAB, whereas 3 observational studies showed that DAPT decreased mortality. One meta-analysis and 4 observational studies showed that DAPT reduced the incidence of cardiac events following OPCAB. One randomized controlled trial and 4 observational studies showed that DAPT did not increase the incidence of major or minor bleeding complications following OPCAB. The results presented suggest that administration of DAPT in patients following OPCAB for at least 3 months improves saphenous vein graft patency and could be protective against recurrence of cardiac events, especially acute coronary syndrome, in comparison with aspirin monotherapy. The administration of DAPT following OPCAB is safe and is not associated with increased incidence of major or minor bleeding complications when compared with aspirin alone.