Shorter DAPT Tested Following CABG

By
Kathryn Wighton
June 8, 2026

Conexiant

Overview

The TOP-CABG trial demonstrated that 3 months of ticagrelor-based dual antiplatelet therapy (DAPT) is noninferior to 12 months of therapy for saphenous vein graft occlusion at 1 year, while significantly reducing bleeding risks. This study involved 2,300 patients undergoing elective coronary artery bypass grafting (CABG), with the primary outcome being noninferiority for SVG occlusion.

Background

The duration of dual antiplatelet therapy following coronary artery bypass grafting (CABG) is crucial for preventing graft occlusion and minimizing bleeding risks. Current guidelines generally recommend prolonged DAPT, particularly in patients with acute coronary syndromes. The findings from the TOP-CABG trial, a multicenter, double-blind study, may influence future recommendations and practices regarding DAPT duration in elective CABG patients.

Data Highlights

{'headers': ['Group', 'Saphenous Vein Graft Occlusion (%)', 'Bleeding Events (%)'], 'rows': [{'Group': '3-month DAPT', 'Saphenous Vein Graft Occlusion (%)': 10.8, 'Bleeding Events (%)': 8}, {'Group': '12-month DAPT', 'Saphenous Vein Graft Occlusion (%)': 11.2, 'Bleeding Events (%)': 13}]}

Key Findings

['3 months of ticagrelor-based DAPT met noninferiority for 1-year SVG occlusion compared to 12 months.', 'Bleeding Academic Research Consortium type 2, 3, or 5 bleeding occurred in 8% of the 3-month group versus 13% in the 12-month group.', 'The number needed to treat to prevent one clinically relevant bleeding event was 21.', 'Major adverse cardiovascular and cerebrovascular events occurred in 2.3% of the 3-month group and 2.7% of the 12-month group.', 'Trial findings were consistent across various sensitivity analyses.', "The trial's primary outcomes included graft-segment-level 100% SVG occlusion at 1 year and bleeding events within 1 year."]

Clinical Implications

The results suggest that a shorter duration of DAPT may be a viable option for selected patients undergoing elective CABG, potentially reducing the risk of bleeding without compromising graft patency. Clinicians should consider individual patient factors, including recent acute coronary syndrome history, when determining the appropriate duration of DAPT.

Conclusion

The TOP-CABG trial supports the use of a 3-month DAPT regimen in elective CABG patients, highlighting a balance between efficacy and safety. Further studies may be needed to confirm these findings across broader patient populations, and limitations of the study should be acknowledged.