[Single versus double antiplatelet therapy following coronary artery bypass grafting]

: Coronary artery bypass grafting is the treatment of choice in complex obstructive coronary artery disease, particularly in diabetic patients. The long-term benefits of coronary artery bypass grafting depend on the successful execution of the anastomosis, on the appropriate choice of conduits (arterial rather than venous) but are also influenced, as for the coronary stent, by the pharmacological measures used to prevent occlusion both in the period immediately following the intervention and in the subsequent years. The use of aspirin at intermediate doses, before and after surgery, clearly improves the clinical prognosis and bypass patency but does not prevent occlusion of venous bypasses from occurring in 10-20% of cases at 1 year of follow-up and in about 50% at 10 years. The combination of aspirin with first or more recent generation thienopyridines (dual antiplatelet therapy, DAPT) has produced conflicting results in the various randomized controlled trials. However, based on the most recent meta-analyses, there seems to be reason for a wider use of DAPT for at least 6 months after surgery for patients undergoing saphenous vein revascularization with a slightly higher risk of bleeding. This strategy could serve to reduce the risk of graft thrombosis as a consequence of the pro-thrombotic and pro-inflammatory state characterizing the first postoperative weeks.