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Background
Coronary artery bypass grafting (CABG) remains one of the most effective surgical interventions for managing advanced coronary artery disease, significantly improving survival and quality of life for patients with complex coronary lesions [1, 2]. However, long-term outcomes following CABG depend not only on the surgical procedure itself but also on the optimization of postoperative management strategies. Among these strategies, dual antiplatelet therapy (DAPT), typically comprising aspirin and a P2Y12 receptor inhibitor such as clopidogrel, has emerged as a cornerstone of care [3, 4]. DAPT reduces the risk of thrombotic events, including graft occlusion and major adverse cardiac and cerebrovascular events (MACCE), and improves long-term graft patency [5, 6–7].
Despite its well-documented benefits, the timing of DAPT initiation after CABG remains a topic of ongoing debate [2, 3]. Current guidelines recommend aspirin administration within 6 h postoperatively; however, the ideal timing for introducing the second antiplatelet agent is less well-defined [8, 9]. Delayed initiation has traditionally been the standard practice in many institutions due to concerns about postoperative bleeding, a complication that can lead to increased morbidity and mortality. Conversely, delaying DAPT may expose patients to a higher risk of thrombotic events during the critical early postoperative period. Balancing these opposing risks presents a significant clinical challenge in our practice.
Although studies have explored the efficacy of DAPT in improving outcomes after CABG, there is limited evidence addressing the optimal timing of its initiation. Institutional audits conducted at our center have revealed significant variability in practice, with initiation times ranging from as early as 4 h to over 24 h postoperatively. This variability underscores the absence of a standardized approach and raises questions about whether earlier initiation could enhance patient outcomes without increasing bleeding risks. Guided by stringent clinical criteria—such as hemodynamic stability, low postoperative drainage output, and adequate platelet counts, this study adopts a comprehensive, phased design, beginning with an institutional audit to assess current practices, followed by a pilot study to establish safety criteria and new standard of practice, and subsequently culminating in a large-scale prospective comparative analysis of early/ new SOP versus delayed/ old SOP DAPT initiation, seeks to address a critical evidence gap on DAPT timing in postoperative CABG care.
Methods
This study was designed as a prospective analysis utilizing retrospectively...
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