DAPT vs. Aspirin: Outcomes Assessed in Post-CABG Patients with Diabetes
HealthDay News — For post-coronary artery bypass grafting (CABG) patients with diabetes, cardiovascular and bleeding outcomes do not differ significantly with use of dual antiplatelet therapy (DAPT) versus aspirin, according to a study published the Journal of the American College of Cardiology.
Sean van Diepen, MD, from the University of Alberta in Edmonton, Canada, and colleagues compared patients receiving DAPT (aspirin plus thienopyridine) and aspirin monotherapy at 30 days postoperatively in a post-hoc nonrandomized analysis from the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of multivessel disease (FREEDOM) trial. The primary outcome was the risk-adjusted five-year FREEDOM composite of all-cause mortality, nonfatal myocardial infarction, or stroke.
The researchers found that 68.4 and 31.6% of patients, respectively, received DAPT and aspirin alone at 30 days post-CABG. The five-year primary composite outcome did not differ significantly between DAPT- and aspirin-treated patients (12.6 versus 16%; adjusted hazard ratio, 0.83; 95% confidence interval, 0.54 to 1.27; P=0.39). The five-year primary composite outcomes were similar for patients receiving DAPT versus aspirin alone in subgroups with pre-CABG acute coronary syndromes and those with stable angina. There were no significant treatment-related differences between the groups in major bleeding, blood transfusions, or hospitalization for bleeding.
"The use of DAPT in patients with diabetes post-CABG in our cohort was high," the authors write. "Compared with aspirin monotherapy, no associated differences were observed in cardiovascular or bleeding outcomes, suggesting that routine use of DAPT may not be clinically warranted."
Two authors disclosed financial ties to the pharmaceutical industry.