Ticagrelor Antiplatelet Therapy to Reduce Graft Events and Thrombosis

This clinical trial will be a randomized double-blind study focusing on ticagrelor antiplatelet therapy as a means of improving vein graft patency after CABG. Patients will be eligible if they have received at least 1 vein bypass graft at time of surgery. Patients will be randomized to receive either aspirin 81 mg bid or ticagrelor 90 mg bid. The aspirin and ticagrelor medications will be prepared in blinded capsules. Patients recovering from surgery will be eligible for study randomization within the first 5 postoperative days. Treatment will continue for 1 year, at which time patients will undergo a CT coronary angiogram to assess graft patency. Patients will then be invited to continue participating in the trial for 1 more year, and a repeat CT coronary angiogram will be performed at the 2 year postoperative time-point.

Inclusion criteria

• Provision of informed consent prior to any study specific procedures
• Female and/or male patients aged 18-90 years
• Patients undergoing first-time CABG with at least 1 saphenous vein graft, irrespective of concurrent valve surgery

Exclusion criteria

• Inability to provide informed consent
• Pregnancy or seeking pregnancy
• Patients undergoing redo-CABG
• Serum creatinine >1.8 mg/dL (need for contrast with CT coronary angiogram)
• Hypersensitivity or allergy to aspirin or ticagrelor
• Anticipated need for postoperative anticoagulation with coumadin, dabigatran or rivaroxaban (mechanical valve, chronic atrial fibrillation, DVT/PE)
• History of gastrointestinal hemorrhage
• Active pathological bleeding
• History of intracranial hemorrhage
• Severe hepatic impairment
• Current or anticipated use of strong CYP3A4 inhibitors (e.g. ketoconazole, clarithromycin, nefazadone, ritonavir, and atazanavir)