From the Guidelines
Daily low-dose aspirin (81-100 mg) is the recommended standard of care for patients with a history of NSTEMI and CABG, rather than every other day, to ensure consistent antiplatelet effect and reduce the risk of graft occlusion and recurrent cardiovascular events. The most recent guidelines from the European Heart Journal in 2024 1 support the use of lifelong low-dose aspirin in patients undergoing CABG, with no mention of every-other-day dosing. The mechanism of action of aspirin as an antiplatelet agent that inhibits thromboxane A2 production is well established, and daily administration is necessary to ensure consistent effect due to the continuous production of new platelets.
Some key points to consider in the management of these patients include:
- The importance of continuing aspirin therapy until the day of CABG and restarting as soon as possible after surgery, ideally within 24 hours, to minimize the risk of bleeding complications 1.
- The potential benefits of dual antiplatelet therapy (DAPT) with a P2Y12 receptor inhibitor compared to aspirin monotherapy in terms of graft patency rates after CABG, although this may be associated with an increased risk of bleeding 1.
- The need for individualized management strategies for patients who cannot tolerate daily aspirin due to side effects, which may involve alternative antiplatelet therapies rather than every-other-day dosing 1.
Overall, the evidence supports the use of daily low-dose aspirin as the standard of care for patients with a history of NSTEMI and CABG, rather than every-other-day dosing, to optimize outcomes and minimize the risk of adverse events.
From the Research
Aspirin Regimen for NSTEMI and CABG Patients
There is limited evidence to support taking low-dose aspirin every other day in patients with a history of Non-ST-Elevation Myocardial Infarction (NSTEMI) and Coronary Artery Bypass Grafting (CABG).
- The provided studies do not specifically address the efficacy of taking low-dose aspirin every other day in patients with NSTEMI and CABG 2, 3, 4, 5, 6.
- However, the studies suggest that antiplatelet therapy, including aspirin, plays a crucial role in reducing the risk of cardiovascular disease after acute myocardial infarction, coronary artery bypass graft, and in chronic atrial fibrillation patients 4.
- The use of dual antiplatelet therapy (DAPT) with aspirin and another antiplatelet agent is recommended for patients with unstable angina and NSTEMI 5.
- A study comparing the efficacy and cost-effectiveness of DAPT versus triple antiplatelet therapy (TAPT) found that DAPT was more cost-effective 5.
- Another study found that aspirin and clopidogrel demonstrated comparable effects on both cardiovascular and bleeding outcomes beyond 1 month and up to 1 year after percutaneous coronary intervention in patients with acute coronary syndrome 6.
Key Findings
- Antiplatelet therapy, including aspirin, is essential for reducing cardiovascular risk in patients with NSTEMI and CABG.
- DAPT with aspirin and another antiplatelet agent is recommended for patients with unstable angina and NSTEMI.
- There is no specific evidence to support taking low-dose aspirin every other day in patients with NSTEMI and CABG.