Inspecting the Aspirin plus Ticagrelor Combination in Preventing Cardiovascular Exacerbation in Patients Undergoing Coronary-Artery Bypass Grafting
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on January 14th, 2026
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In many countries, long-term aspirin therapy is routinely recommended for patients who have undergone coronary-artery bypass grafting. More recent guidelines have suggested adding a P2Y12 inhibitor to aspirin, although the evidence supporting this approach remains limited. To address this question, a study funded by the Swedish Research Council evaluated the cardiovascular benefits and risks of combining aspirin with ticagrelor in patients following CABG.
The study was conducted across Denmark, Finland, Iceland, Norway, and Sweden and enrolled 2,201 patients with a mean age of approximately 66 years. All participants had undergone coronary-artery bypass grafting within the previous six weeks. The surgery was most commonly performed for non-ST-elevation myocardial infarction (about 57% of cases), followed by unstable angina (around 32%) and ST-elevation myocardial infarction (approximately 10%). Among the cohort, 9% had a history of heart failure, 68.5% had hypertension, and 3.3% had experienced a prior stroke. Nearly 30% had a left ventricular ejection fraction below 50%.
Participants were randomly assigned to receive either aspirin alone at a daily dose of 75 to 160 mg, or dual therapy with ticagrelor 180 mg daily plus aspirin 75 to 100 mg. Ticagrelor works by inhibiting the platelet P2Y12 receptor, thereby reducing thrombus formation.
After one year of follow-up, the study found no difference between aspirin monotherapy and the aspirin–ticagrelor combination in reducing the risk of death, myocardial infarction, or stroke. However, patients receiving ticagrelor experienced significantly higher rates of major bleeding and severe dyspnea. These findings suggest that adding ticagrelor to aspirin after coronary-artery bypass grafting does not provide additional cardiovascular benefit and may increase harm. Similar results have been reported in other studies examining dual antiplatelet therapy in patients without prior CABG.
The study was conducted across Denmark, Finland, Iceland, Norway, and Sweden and enrolled 2,201 patients with a mean age of approximately 66 years. All participants had undergone coronary-artery bypass grafting within the previous six weeks. The surgery was most commonly performed for non-ST-elevation myocardial infarction (about 57% of cases), followed by unstable angina (around 32%) and ST-elevation myocardial infarction (approximately 10%). Among the cohort, 9% had a history of heart failure, 68.5% had hypertension, and 3.3% had experienced a prior stroke. Nearly 30% had a left ventricular ejection fraction below 50%.
Participants were randomly assigned to receive either aspirin alone at a daily dose of 75 to 160 mg, or dual therapy with ticagrelor 180 mg daily plus aspirin 75 to 100 mg. Ticagrelor works by inhibiting the platelet P2Y12 receptor, thereby reducing thrombus formation.
After one year of follow-up, the study found no difference between aspirin monotherapy and the aspirin–ticagrelor combination in reducing the risk of death, myocardial infarction, or stroke. However, patients receiving ticagrelor experienced significantly higher rates of major bleeding and severe dyspnea. These findings suggest that adding ticagrelor to aspirin after coronary-artery bypass grafting does not provide additional cardiovascular benefit and may increase harm. Similar results have been reported in other studies examining dual antiplatelet therapy in patients without prior CABG.