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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SpringerOpen
2025-01-01
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| Series: | The Cardiothoracic Surgeon |
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| Online Access: | https://doi.org/10.1186/s43057-025-00149-1 |
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| author | Yen Chuan Chen Khairul Anuar Abdul Aziz Mohamed Ezani Md Taib Alwi Mohamed Yunus Intan Fariza Gaaffar |
| author_facet | Yen Chuan Chen Khairul Anuar Abdul Aziz Mohamed Ezani Md Taib Alwi Mohamed Yunus Intan Fariza Gaaffar |
| author_sort | Yen Chuan Chen |
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| description | 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. |
| format | Article |
| id | doaj-art-e872f594e8c9416dbf76e7837ce280f3 |
| institution | Kabale University |
| issn | 2662-2203 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | The Cardiothoracic Surgeon |
| spelling | doaj-art-e872f594e8c9416dbf76e7837ce280f32025-01-26T12:53:03ZengSpringerOpenThe Cardiothoracic Surgeon2662-22032025-01-0133111010.1186/s43057-025-00149-1Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysisYen Chuan Chen0Khairul Anuar Abdul Aziz1Mohamed Ezani Md Taib2Alwi Mohamed Yunus3Intan Fariza Gaaffar4Cardiothoracic and Vascular Surgery Department, Institut Jantung NegaraCardiothoracic and Vascular Surgery Department, Institut Jantung NegaraCardiothoracic and Vascular Surgery Department, Institut Jantung NegaraCardiothoracic and Vascular Surgery Department, Institut Jantung NegaraClinical Research Department, Institut Jantung NegaraAbstract 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.https://doi.org/10.1186/s43057-025-00149-1Dual antiplatelet therapyCoronary artery bypass graftingPostoperative careBleeding complicationsStroke prevention |
| spellingShingle | Yen Chuan Chen Khairul Anuar Abdul Aziz Mohamed Ezani Md Taib Alwi Mohamed Yunus Intan Fariza Gaaffar Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis The Cardiothoracic Surgeon Dual antiplatelet therapy Coronary artery bypass grafting Postoperative care Bleeding complications Stroke prevention |
| title | Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis |
| title_full | Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis |
| title_fullStr | Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis |
| title_full_unstemmed | Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis |
| title_short | Early dual antiplatelet therapy (DAPT) administration within 6 h post-coronary artery bypass grafting (CABG): an audit, pilot study, and follow-up analysis |
| title_sort | early dual antiplatelet therapy dapt administration within 6 h post coronary artery bypass grafting cabg an audit pilot study and follow up analysis |
| topic | Dual antiplatelet therapy Coronary artery bypass grafting Postoperative care Bleeding complications Stroke prevention |
| url | https://doi.org/10.1186/s43057-025-00149-1 |
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