{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:15:17Z","timestamp":1793124917573,"version":"4.5.0"},"reference-count":61,"publisher":"BMJ","license":[{"start":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T00:00:00Z","timestamp":1570665600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and network meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria<\/jats:title>\n                    <jats:p>\n                      <jats:bold>for selecting studies<\/jats:bold>\n                      Randomised controlled trials of participants (aged \u226518) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study registration<\/jats:title>\n                    <jats:p>PROSPERO registration number CRD42017065678.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmj.l5476","type":"journal-article","created":{"date-parts":[[2019,10,10]],"date-time":"2019-10-10T10:08:30Z","timestamp":1570702110000},"page":"l5476","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":98,"title":["Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis"],"prefix":"10.1136","author":[{"given":"Karla","family":"Solo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahar","family":"Lavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conrad","family":"Kabali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn N","family":"Levine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Kulik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ava A","family":"John-Baptiste","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen E","family":"Fremes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W","family":"Eikelboom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ruel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlay A","family":"Huitema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tawfiq","family":"Choudhury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak L","family":"Bhatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Tzemos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamas A","family":"Mamas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1888-9429","authenticated-orcid":false,"given":"Rodrigo","family":"Bagur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,10]]},"reference":[{"key":"key20191011000253_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.001"},{"key":"key20191011000253_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy394"},{"key":"key20191011000253_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(96)00206-9"},{"key":"key20191011000253_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.06.067"},{"key":"key20191011000253_ref5","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.040311"},{"key":"key20191011000253_ref6","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.116.002708"},{"key":"key20191011000253_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3793"},{"key":"key20191011000253_ref8","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(96)80135-7"},{"key":"key20191011000253_ref9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.19.2446"},{"key":"key20191011000253_ref10","doi-asserted-by":"publisher","DOI":"10.1097\/00001573-198711000-00007"},{"key":"key20191011000253_ref11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.08.064"},{"key":"key20191011000253_ref12","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2016.76"},{"key":"key20191011000253_ref13","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu278"},{"key":"key20191011000253_ref14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.03.104"},{"key":"key20191011000253_ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.07.035"},{"key":"key20191011000253_ref16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.3197"},{"key":"key20191011000253_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.10.048"},{"key":"key20191011000253_ref18","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000182"},{"key":"key20191011000253_ref19","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev164"},{"key":"key20191011000253_ref20","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aew072"},{"key":"key20191011000253_ref21","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.05.187"},{"key":"key20191011000253_ref22","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2385"},{"key":"key20191011000253_ref23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019555"},{"key":"key20191011000253_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2017.06.039"},{"key":"key20191011000253_ref25","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197911013011803"},{"key":"key20191011000253_ref26","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0022-5223(19)37328-3","article-title":"The effect of antithrombotic therapy on patency rates of saphenous vein coronary artery bypass grafts","volume":"83","author":"McEnany","year":"1982","journal-title":"J Thorac Cardiovasc Surg"},{"key":"key20191011000253_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(84)92446-2"},{"key":"key20191011000253_ref28","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.1993.tb137909.x"},{"key":"key20191011000253_ref29","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.72.1.138"},{"key":"key20191011000253_ref30","first-page":"II218","article-title":"The effect of antiplatelet therapy on saphenous vein coronary artery bypass graft patency","volume":"68","author":"Sharma","year":"1983","journal-title":"Circulation"},{"key":"key20191011000253_ref31","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.83.5.1526"},{"key":"key20191011000253_ref32","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.80.5.1190"},{"key":"key20191011000253_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(93)91815-4"},{"key":"key20191011000253_ref34","doi-asserted-by":"publisher","DOI":"10.9734\/BJMMR\/2016\/24386"},{"key":"key20191011000253_ref35","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-302449"},{"key":"key20191011000253_ref36","doi-asserted-by":"publisher","DOI":"10.1097\/imi.0b013e3181bbc754"},{"key":"key20191011000253_ref37","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.978007"},{"key":"key20191011000253_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.04.024"},{"key":"key20191011000253_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.10.032"},{"key":"key20191011000253_ref40","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308691"},{"key":"key20191011000253_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(88)90060-8"},{"key":"key20191011000253_ref42","volume-title":"Predictors of early saphenous vein graft patency, platelet hyper-reactivity and aspirin-insensitive thromboxane generation in patients undergoing coronary artery bypass graft surgery.","author":"Nazarian","year":"2009"},{"key":"key20191011000253_ref43","doi-asserted-by":"publisher","DOI":"10.1370\/afm.141"},{"key":"key20191011000253_ref44","first-page":"29","article-title":"A revised tool for assessing risk of bias in randomized trials","volume":"10","author":"Higgins","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"key20191011000253_ref45","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2017.10.005"},{"key":"key20191011000253_ref46","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1044"},{"key":"key20191011000253_ref47","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0076654"},{"key":"key20191011000253_ref48","doi-asserted-by":"publisher","DOI":"10.1177\/1740774512470317"},{"key":"key20191011000253_ref49","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dys041"},{"key":"key20191011000253_ref50","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz185"},{"key":"key20191011000253_ref51","doi-asserted-by":"crossref","first-page":"e123","DOI":"10.1161\/CIR.0000000000000404","article-title":"2016 ACC\/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines: an update of the 2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF\/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC\/AHA\/ACP\/AATS\/PCNA\/SCAI\/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF\/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA\/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC\/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery","volume":"134","author":"Levine","year":"2016","journal-title":"Circulation"},{"key":"key20191011000253_ref52","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.07.086"},{"key":"key20191011000253_ref53","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx419"},{"key":"key20191011000253_ref54","doi-asserted-by":"publisher","DOI":"10.1111\/jocs.12074"},{"key":"key20191011000253_ref55","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2013.07.017"},{"key":"key20191011000253_ref56","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"key20191011000253_ref57","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1709118"},{"key":"key20191011000253_ref58","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000217920.48559.D8"},{"key":"key20191011000253_ref59","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2009.214551"},{"key":"key20191011000253_ref60","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.096"},{"key":"key20191011000253_ref61","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.040311"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.l5476","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.l5476","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,24]],"date-time":"2021-01-24T07:56:02Z","timestamp":1611474962000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.l5476"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,10]]},"references-count":61,"alternative-id":["10.1136\/bmj.l5476"],"URL":"https:\/\/doi.org\/10.1136\/bmj.l5476","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.736742040.793566416","asserted-by":"object"}]},"ISSN":["0959-8138","1756-1833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1756-1833","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,10]]}}}