Shortened dual antiplatelet therapy after CABG: important evidence but unanswered questions remain

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Agreement: I Agree Body: Dear Editor, I read with great interest the study conducted on three months versus 12 months of dual antiplatelet therapy (DAPT) using ticagrelor and aspirin after saphenous vein grafting during coronary artery bypass surgery (CABG). We compliment the authors for conducting a large scale, double blind, multicenter non-inferiority study on an important clinical topic. The observation that three-month DAPT is as effective as 12-month DAPT in terms of graft occlusion but reduced type 2-5 bleeding by 4.67% within one year is clinically relevant and proves that shorter DAPT is advantageous. However, this study has some limitations. Firstly, the main outcome, which is the graft occlusion at one year based on angiography, might not represent the long-term clinical end-points like myocardial infarction, revascularization, or cardiovascular mortality since the study was not designed to evaluate these outcome measures and required more follow up because of the progressive nature of vein graft disease. Secondly, all patients enrolled were from China and therefore the results may have limited generalizability to other populations. Lastly, the effect of subgrouping of high-risk patients such as those with diabetes, CKD, and multiple vein grafts needs to be evaluated further for determining the optimum DAPT regimen. Despite all this, the study has brought out significant data regarding DAPT for some CABG patients. More multinational trials with longer follow-up are needed before universal implementation of this strategy. No competing Interests: Yes The following competing Interests: Electronic Publication Date: Sunday, July 5, 2026 - 07:52 AI use: No, I have not used AI Highwire Comment Subject: Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial Workflow State: Released Full Title: Shortened dual antiplatelet therapy after CABG: important evidence but unanswered questions remain Highwire Comment Response to: Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial Check this box if you would like your letter to appear anonymously:: Last Name: Malik First name and middle initial: Muhammad Abdullah Javed Email: [email protected] Address: Wah medical college wah cantt pakistan Occupation: Student Affiliation: Wah medical college BMJ: Additional Article Info: Rapid response