Comparative outcomes of anticoagulant versus antiplatelet therapy in coronary endarterectomy: a meta-analysis

Abstract Background Coronary endarterectomy (CE) has recently returned to the limelight due to its advantages in achieving full revascularization in very complex cases. However, to date, there are no guidelines concerning the use of postoperative antiplatelet and anticoagulant therapy (ACT). Aim In light of this, the present meta-analysis aimed to compare the impact of ACT versus antiplatelet therapy on short- and long-term outcomes after CE. Methods PubMed, Embase, and Medline databases were searched without any restriction on the year or the language. Two reviewers screened the studies in two rounds in a blinded manner and extracted the data into an Excel spreadsheet. The third reviewer reconciled discrepancies. Results Nineteen studies made our final selection. Short- and long-term mortality was similar between patients treated with ACT and those receiving double antiplatelet therapy (DAPT) ( p = 0.15 and p = 0.98, respectively). Short-term myocardial infarction (MI) was significantly lower among DAPT patients ( p < 0.001); while during the long-term follow-up, MI events were similar ( p = 0.77). Dual antiplatelet agents were also compared, suggesting that DAPT with aspirin + clopidogrel and aspirin + ticagrelor regimens lead to similar long-term graft patency ( p = 0.09). Conclusion Postoperative mortality seems to be not affected by the anticoagulant/antiplatelet therapy after CE. DAPT leads to a greater reduction in short-term MI rates; thus, the postoperative use of DAPT seems to offer more benefits compared to ACT therapy. Long-term MI events, however, were comparable. Long-term graft patency analysis of DAPT with aspirin + clopidogrel and aspirin + ticagrelor has not revealed any superiority.