Our Summary

This study investigated how doctors in the UK and Ireland use dual-antiplatelet therapy (DAPT) after a coronary artery bypass graft (CABG) operation, which is a surgical procedure to improve blood flow to the heart. DAPT, a combination of aspirin and a P2Y12 antagonist, is used to stop blood clots from forming.

The research included an online survey sent to adult heart surgeons. The results came mainly from the UK, with a small portion from Scotland, Northern Ireland, Wales and Ireland.

The majority of the surgeons (91%) indicated that they prescribe DAPT after the operation, but the specific patients who receive it varied. DAPT is typically given to patients with particular conditions such as acute coronary syndrome, diffuse coronary artery disease, perioperative myocardial infarction, coronary endarterectomy, or when bypassing a stented coronary artery.

However, not all patients received DAPT, with 38% of surgeons saying they start all their CABG patients on this treatment. The preferred drug to combine with aspirin was clopidogrel, which was usually given on the first day after surgery. Most surgeons preferred to continue the treatment for 12 months.

The main reason some patients did not receive DAPT was the risk of bleeding associated with this treatment. The researchers concluded that there is a need for standardised guidelines on the use of DAPT after CABG, due to the variations in its use.

FAQs

  1. What is dual-antiplatelet therapy (DAPT) and why is it used after a coronary artery bypass graft (CABG) operation?
  2. What is the primary reason some patients do not receive DAPT after the CABG operation?
  3. What did the researchers conclude about the use of DAPT after CABG and what are their recommendations for future practices?

Doctor’s Tip

One helpful tip a doctor might tell a patient about coronary artery bypass is to make sure to follow their prescribed dual-antiplatelet therapy (DAPT) regimen after the surgery. It is important to take the medication as directed to prevent blood clots and improve the success of the bypass procedure. Additionally, it is important to discuss any concerns about potential side effects or bleeding risks with the doctor.

Suitable For

In summary, patients who are typically recommended coronary artery bypass surgery include those with acute coronary syndrome, diffuse coronary artery disease, perioperative myocardial infarction, coronary endarterectomy, or those bypassing a stented coronary artery. The decision to prescribe dual-antiplatelet therapy (DAPT) after the operation varies among surgeons, with some starting all patients on it and others only prescribing it to specific patient populations due to the risk of bleeding. There is a need for standardised guidelines on the use of DAPT after CABG to ensure consistent and appropriate treatment for all patients.

Timeline

  • Before coronary artery bypass surgery: Patients typically undergo diagnostic tests such as angiography to determine the extent of blockages in the coronary arteries. They may also undergo lifestyle changes, medications, and other treatments to manage their heart disease.

  • During coronary artery bypass surgery: The surgeon will create new pathways for blood to flow to the heart by using blood vessels from other parts of the body, such as the chest or leg. The surgery can take several hours, and the patient will be under anesthesia.

  • After coronary artery bypass surgery: Patients are typically monitored in the intensive care unit for a day or two before being moved to a regular hospital room. They will be given medications to manage pain, prevent infection, and reduce the risk of blood clots. Patients will also undergo physical therapy to help with recovery and rehabilitation.

  • Post-surgery follow-up: Patients will have regular follow-up appointments with their healthcare provider to monitor their progress and make any necessary adjustments to their treatment plan. They will also be advised on lifestyle changes, such as diet and exercise, to improve their heart health.

What to Ask Your Doctor

  1. Should I be on dual-antiplatelet therapy (DAPT) after my coronary artery bypass surgery?
  2. What are the potential benefits and risks of DAPT in my specific case?
  3. How long do you recommend I stay on DAPT after the surgery?
  4. Are there any specific conditions or factors that would make me a better candidate for DAPT?
  5. What are the potential side effects of the medications used in DAPT?
  6. How will DAPT interact with any other medications I am currently taking?
  7. What should I do if I experience any side effects or complications while on DAPT?
  8. Are there any lifestyle changes or precautions I should take while on DAPT?
  9. How frequently should I follow up with you to monitor the effectiveness of DAPT?
  10. Are there any specific warning signs or symptoms I should be aware of while on DAPT?

Reference

Authors: Comanici M, Raja SG. Journal: J Cardiothorac Vasc Anesth. 2023 Dec;37(12):2517-2523. doi: 10.1053/j.jvca.2023.08.146. Epub 2023 Aug 27. PMID: 37802690