New data suggest that use of dual antiplatelet therapy may not be clinically warranted in patients with diabetes post-CABG.
According to data published in the Journal of the American College of Cardiology, there was no significant difference in CV or bleeding outcomes between patients treated with aspirin monotherapy vs. DAPT.
“In a secondary analysis of the FREEDOM trial, we observed that use of DAPT in patients with diabetes post-CABG was high, and, compared with aspirin monotherapy, no significant associations were observed with all-cause mortality, MI or stroke,” Sean van Diepen, MD, MSc, from the department of critical care and division of cardiology at the University of Alberta in Edmonton, Canada, and colleagues wrote.
Researchers compared patients receiving DAPT and aspirin monotherapy at 30 days postoperatively, using previously published data from the international multicenter FREEDOM trial.
All patients who underwent primary revascularization with CABG and assigned aspirin 30 days postoperatively were included in the study.
The primary analysis concerned 5-year outcomes in patients who received DAPT vs. those who received aspirin alone 30 days after CABG.
The primary outcome was risk-adjusted 5-year FREEDOM composite of all-cause mortality, nonfatal MI or stroke.
Outcomes for safety were major bleeding, blood transfusion and hospitalization for bleeding.
Thirty days after CABG, 68.4% (n = 544) of patients received DAPT and 31.6% (n = 251) received solely aspirin, the researchers wrote.
There was a median duration of clopidogrel therapy of 0.98 years.
The difference in the 5-year primary composite outcome between DAPT- and aspirin-treated patients was not significantly different (DAPT, 12.6%; aspirin,16%; adjusted HR = 0.83; 95% CI, 0.54-1.27).
Primary composite outcomes at 5 years were similar for patients receiving DAPT vs. aspirin monotherapy, respectively, in subgroups with pre-CABG ACS (15.2% vs. 16.5%; HR = 1.06; 95% CI, 0.53-2.1) and those with stable angina (11.6% vs. 15.8%; HR = 0.82; 95% CI, 0.5-1.343), according to the findings.
Composite outcomes in both treatment cohorts had similar SYNTAX scores, duration of DAPT, completeness of revascularization and use of off-pump CABG.
Researchers did not observe any treatment-related differences in major bleeding (aspirin, 5.6%; DAPT, 5.7%; HR = 1; 95% CI, 0.5-1.99), blood transfusions (aspirin, 4.8%; DAPT, 4.5%; HR = 1.09; 95% CI, 0.51-2.34) or hospitalization for bleeding (aspirin, 2.6%; DAPT, 3.3%; HR = 0.85; 95% CI, 0.34-2.17) between the groups.
Glenn N. Levine
“There is modest but not definitive data on potential benefits of DAPT post-CABG, including in patients with ACS and patients with diabetes,” Glenn N. Levine, MD, from the department of medicine at Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston, and Faisal G. Bakaeen, MD, from the Heart and Vascular Institute, department of thoracic and cardiovascular surgery at Cleveland Clinic, wrote in an accompanying editorial. “Whether findings from this current study lead to modifications of future guideline recommendations or impact practice patterns remains to be determined.” – by Dave Quaile
Disclosure: van Diepen reports receiving honoraria and grant support from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Janssen, Lilly, Pfizer, Merck, Novartis and Sorin.
Please see the full study for a list of all other researchers’ relevant financial disclosures. Levine and Bakaeen report no relevant financial disclosures.