Antithrombotic therapy after coronary artery bypass grafting: how to improve prognosis and preserve grafts

Antithrombotic therapy is an integral component of treatment designed to ensure long-term patency of grafts and improve prognosis in patients undergoing coronary artery bypass grafting. The authors review optimal antithrombotic treatment strategies for different categories of patients — those with stable coronary artery disease, acute coronary syndromes, concomitant atrial fibrillation, and heart valve disease. A particular attention is paid to clinical situations associated with high risk of graft failure (complex coronary reconstructions, “compromised” distal bed, coronary endarterectomy). Standard aspirin monotherapy and various options for “intensified” treatment, including addition of the second antithrombotic drug (P2Y12 receptor blocker or anticoagulant), are considered.