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DACAB: Ticagrelor Plus Aspirin Improves CABG Graft Patency

 A new trial shows the combination of aspirin plus ticagrelor (Brilinta, AstraZeneca) resulted in significant improvement in saphenous vein graft (SVG) patency at 12 months compared with aspirin alone in patients undergoing CABG.

Patency was better with ticagrelor plus aspirin compared with either agent alone, although the results were only statistically significant for dual therapy vs aspirin.


The saphenous vein graft is the still the most commonly used graft for CABG. Failure rates for this graft, though, are estimated at between 10% and 25% after the first year and 50% by 10 years postprocedure.

In DACAB, investigators undertook to assess the efficacy and safety of a dual antiplatelet strategy of aspirin plus ticagrelor vs ticagrelor alone and aspirin alone 1 year after elective CABG surgery.

The primary outcome was SVG patency assessed using CT scan and coronary angiography at 1 year using intention-to-treat analysis. Secondary outcomes included SVG patency at 7 days, MACE or recurrence of angina within a year, atrial fibrillation at 7 days, and bleeding events using TIMI criteria within the 1 year follow-up.

Combination therapy with ticagrelor and aspirin had a better outcome than aspirin monotherapy. The overall vein graft patency for dual therapy at 1 year is 88.7%, and in the aspirin group was 76.5%. The difference is 12.2%, which is statistically significant (P=0.0006).


DACAB: SVG Outcomes at 1 Year (Intention to Treat)

End Point

Ticagrelor + Aspirin (%)

Ticagrelor (%)

Aspirin (%)

Patency (Fitzgibbon A)

 88.7  82.8  76.5

Nonocclusion (Fitzgibbon A + B)

 89.9  86.1  80.6