Weekly Journal Scan: Redefining the duration of dual antiplatelet therapy after coronary artery bypass grafting

This comment refers to ‘Efficacy of dual antiplatelet therapy for three months versus 12 months after coronary artery bypass grafting: multicentre, double blinded, randomised controlled trial’ which was published in the British Medical Journal, https://doi.org/10.1136/bmj-2025-088939. CABG remains the most frequently performed cardiac surgery worldwide and represents one of the most effective strategies for long-term prevention of recurrent ischaemic events in patients with advanced CAD.2 Despite its established clinical benefit, the optimal antiplatelet strategy after CABG remains uncertain. Unlike percutaneous coronary intervention (PCI), where prolonged platelet inhibition is driven by the need to prevent stent thrombosis in addition to atherothrombotic events, the biology of CABG is dominated by the competing objectives of preserving graft patency while minimizing bleeding risk, particularly in the perioperative period.3 The mechanisms underlying graft failure, particularly SVGs, are dynamic and evolve over time: early graft occlusion is predominantly driven by endothelial disruption related to surgical harvesting and implantation, resulting in platelet activation and thrombotic events, whereas late failure is mainly characterized by progressive intimal hyperplasia and accelerated atherosclerosis.4,5 This time-dependent pathophysiology provides a biological rationale for intensified platelet inhibition during the early period of heightened thrombotic susceptibility, while challenging the incremental benefit of prolonged DAPT once graft healing and endothelialization have occurred.5