Evidence mapPaperPMID 42418138Full record

ReviewJournal of thrombosis and thrombolysis2026

Dual antiplatelet therapy with aspirin and ticagrelor vs aspirin alone in patients with acute coronary syndrome undergoing coronary artery bypass graft surgery: a systematic review and meta-analysis.

Najat Y AlSejari, Ahmed Farid Gadelmawla, Amal A Alsubaiei, Asayel M Alsultan, Abdulrahman N Alawadhi, Ali Alwazzan, Mahdi Abdulhadi Alwazzan, Mooza Isa Alkubaisi, Danah AlSafy, Rataj Naser Alattar and 5 more

Abstract readReview
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In one paragraph

Review in Journal of thrombosis and thrombolysis, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Najat Y AlSejari *Kuwait Institute for Medical Specializations, Kuwait City, Kuwait.
Ahmed Farid Gadelmawla *Faculty of Medicine, Menoufia University, Menoufia, Egypt.
Amal A AlsubaieiKuwait Institute for Medical Specializations, Kuwait City, Kuwait.
Asayel M AlsultanKuwait Institute for Medical Specializations, Kuwait City, Kuwait.
Abdulrahman N AlawadhiUniversity of Jordan, Amman, Jordan.
Ali AlwazzanUniversity of Jordan, Amman, Jordan.
Mahdi Abdulhadi AlwazzanUniversity of Jordan, Amman, Jordan.
Mooza Isa AlkubaisiCollege of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Danah AlSafyUniversity of Jordan, Amman, Jordan.
Rataj Naser AlattarUniversity of Jordan, Amman, Jordan.
Abdulaziz Saud AlzeabyCollege of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Hamidah Abdulhadi AlwazzanUniversity of Jordan, Amman, Jordan.
Estabraq AlaskariUniversity of Jordan, Amman, Jordan.
Esra Abdullah AlMadsariCollege of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
Abdullah M AlharranCollege of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain. Dr_alharran@outlook.com.ORCID http://orcid.org/0009-0003-2337-6588

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The role of dual antiplatelet therapy (DAPT) with ticagrelor plus aspirin after coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) remains uncertain. We performed a systematic review and meta-analysis to compare ticagrelor plus aspirin versus aspirin alone in ACS patients undergoing CABG. We performed a comprehensive search of MEDLINE, Cochrane Library, Scopus, and Web of Science for studies that compared ticagrelor plus aspirin to aspirin alone in patients with ACS undergoing CABG. The main meta-analysis was restricted to randomized controlled trials, while observational evidence was incorporated only in exploratory analyses. Outcomes including myocardial infarction (MI), ischemic stroke, all-cause mortality, bleeding, repeat revascularization, graft occlusion, and major adverse cardiovascular events (MACE) were analyzed. Risk of bias was assessed using Rob-2 for RCTs and the Newcastle-Ottawa Scale (NOS) for cohort studies. GRADE was used to assess the certainty of the evidence. Seven articles representing five studies were included. There were no significant differences in myocardial infarction (MI) (OR: 0.95, 95% CI 0.53-1.72), ischemic stroke, all-cause mortality, while a significant increase in major bleeding was observed. No difference was also found in repeat revascularization, graft occlusion, or minor bleeding. Sensitivity analyses identified single studies as key sources of heterogeneity for several outcomes. In the combined analysis including randomized and observational evidence, ticagrelor plus aspirin showed a lower risk of study-defined MACE compared with aspirin alone (OR 0.6, 95% CI 0.43-0.83) although this estimate was based on only two studies and was largely driven by one observational cohort. Ticagrelor plus aspirin after CABG for ACS significantly increased major bleeding, while other ischemic, graft-related, and minor bleeding outcomes showed no consistent significant differences. Further high-quality randomized evidence is needed to clarify the net clinical benefit of this strategy.

Indexed as

Acute coronary syndromeaspirincoronary artery bypass graftingdual antiplatelet therapy.ticagrelor

Identifiers

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.