Antiplatelet Therapy Recommendations

1. Aspirin should be administered preoperatively and within 6 hours after CABG in doses of 81 to 325 mg daily. It should then be continued indefinitely to reduce graft occlusion and adverse cardiac events (Class I; Level of Evidence A).
2. After off-pump CABG, dual antiplatelet should be administered for 1 year with combined aspirin (81– 162 mg daily) and clopidogrel 75 mg daily to reduce graft occlusion (Class I; Level of Evidence A).
3. Clopidogrel 75 mg daily is a reasonable alternative after CABG for patients who are intolerant of or allergic to aspirin. It is reasonable to continue it indefinitely (Class IIa; Level of Evidence C).
4. In patients who present with acute coronary syndrome, it is reasonable to administer combination antiplatelet therapy after CABG with aspirin and either prasugrel or ticagrelor (preferred over clopidogrel), although prospective clinical trial data from CABG populations are not yet available (Class IIa; Level of Evidence B).
5. As sole antiplatelet therapy after CABG, it is reasonable to consider a higher aspirin dose (325 mg daily) rather than a lower aspirin dose (81 mg daily), presumably to prevent aspirin resistance, but the benefits are not well established (Class IIa; Level of Evidence A).
6. Combination therapy with both aspirin and clopidogrel for 1 year after on-pump CABG may be considered in patients without recent acute coronary syndrome, but the benefits are not well established (Class IIb; Level of Evidence Level A).