Ticagrelor-Based Dual Antiplatelet Therapy Duration in CABG

Launched by KEXIANG LIU, MD · May 13, 2025

Keywords

ClinConnect Summary

This clinical trial is studying how long patients should take a medication called Ticagrelor, along with aspirin, after undergoing coronary artery bypass grafting (CABG) surgery. The goal is to find out whether taking this combination of medications for 3, 6, or 12 months can help keep the saphenous vein grafts (the veins used to bypass blocked arteries) open and functioning well. The researchers want to see which duration not only helps the grafts stay open but also has the least risk of causing bleeding problems. About 300 patients will participate, and their graft health will be checked a year after surgery using a special type of imaging called coronary CT angiography.

To be eligible for this trial, participants need to be between 18 and 80 years old and scheduled for their first CABG surgery with at least one saphenous vein graft. However, people with certain health issues, such as those needing other heart surgeries at the same time or those with specific medical conditions that could complicate the study, won’t be included. If you join the trial, you can expect to be randomly assigned to one of the three treatment groups for the duration of Ticagrelor and aspirin therapy, followed by aspirin alone. The study aims to help improve care for CABG patients by figuring out the best approach to using these medications after surgery.

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Eligibility criteria

• Inclusion Criteria:
• • 1. Patients 18-80 of age.
• • 2. Patients undergo planned CABG for the first time with ≥1 SVGs
• • 3. Patients with written informed consent.
• Exclusion Criteria:
• • 1. Patients undergoing concomitant valve surgery (excluding aortic bioprosthesis), aortic surgery, or rhythm surgery during the same session.
• • 2. Patients undergoing emergency CABG.
• • 3. Patients with single-vessel coronary artery disease.
• • 4. Patients with cardiogenic shock or hemodynamic instability.
• • 5. Patients with sick sinus syndrome, second- or third-degree atrioventricular block.
• • 6. Patients with contraindications for coronary computed tomography angiography (CCTA) or coronary angiography, including contrast media allergy.
• • 7. Patients requiring antiplatelet therapy other than aspirin or ticagrelor (e.g., clopidogrel, prasugrel) and unable to discontinue such medication after CABG, based on physician or investigator judgment.
• • 8. Patients on oral anticoagulants before CABG who must continue anticoagulation therapy postoperatively.
• 9. Patients with contraindications for ticagrelor or aspirin, including:
• • 9.1Bleeding diathesis within the past 3 months. 9.2Severe gastrointestinal bleeding within the past year. 9.3Peptic ulcer (even without bleeding) within the past 3 years. 9.4History of intracranial hemorrhage, aspirin allergy, or severe aspirin-induced gastrointestinal reaction.
• • 10. Patients with a drug-eluting stent (DES) in a coronary or cerebral artery within 6 months before CABG, or a bare-metal stent (BMS) within 1 month before CABG.
• • 11. Patients with thrombocytopenia (\<100 x 10⁹/L) before CABG.
• • 12. Patients with severe renal dysfunction requiring dialysis or active liver disease, including unexplained persistent transaminase elevation or transaminase levels \>3× the upper normal limit.
• • 13. Patients using strong CYP3A4 inhibitors.
• • 14. Patients requiring methotrexate and ibuprofen therapy.
• • 15. Patients with active malignant tumors with an increased risk of bleeding, as determined by the investigator.
• • 16. Pregnant or breastfeeding women, and those who have given birth within the past 90 days.
• • 17. Premenopausal women not using adequate contraception. Adequate contraception requires at least two reliable methods, including one barrier method.