Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis
Abstract Background The optimal timing for administering dual antiplatelet therapy (DAPT) post-coronary artery bypass grafting (CABG) remains a subject of debate. This study aimed to evaluate the safety and efficacy of early DAPT administration within 6 h post-CABG, following the implementation of a...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-01-01
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| Series: | The Cardiothoracic Surgeon |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43057-025-00149-1 |
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| Summary: | Abstract Background The optimal timing for administering dual antiplatelet therapy (DAPT) post-coronary artery bypass grafting (CABG) remains a subject of debate. This study aimed to evaluate the safety and efficacy of early DAPT administration within 6 h post-CABG, following the implementation of a new standard operating procedure (SOP). This study was conducted in three phases at the National Heart Institute of Malaysia. Phase 1 involved a clinical audit of 80 isolated CABG patients to evaluate current DAPT practices. Phase 2 was a pilot study involving 320 patients to establish criteria for early DAPT initiation. Phase 3 comprised a prospective cohort analysis comparing outcomes between 939 propensity-matched pairs receiving early/new SOP (< 6 h) and late/old SOP (> 6 h) DAPT. Results The clinical audit revealed a mean DAPT administration time of 18.3 h post-CABG, highlighting variability in practice. The pilot study demonstrated that early DAPT was associated with a significantly lower chest reopening rate (0.8% vs. 21.6%) under stringent selection criteria. In the follow-up study, early DAPT was linked to reduced rates of postoperative stroke (1.0% vs. 2.5%, p = 0.013), dialysis (5.5% vs. 7.0%, p < 0.001), and chest reoperation (6.5% vs. 9.0%, p = 0.045). Despite a higher transfusion rate in the early DAPT group (76.0% vs. 43.6%, p < 0.001), ICU stays and hospitalization durations were not prolonged. Mortality rates were lower in the early DAPT group (3.2% vs. 4.6%), although the difference was not statistically significant (p = 0.123). Conclusions Guided by stringent clinical criteria, early DAPT administration within 6 h post-CABG is a feasible and effective strategy for reducing adverse outcomes, such as stroke and dialysis requirements, while maintaining manageable bleeding risks. Future research should explore long-term graft patency, refine transfusion protocols, and assess the broader applicability of this approach. |
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| ISSN: | 2662-2203 |