Three hundred OPCAB patients without a history of diabetes mellitus were randomized to receive either aspirin 100 mg plus clopidogrel 75 mg daily or aspirin 100 mg daily for 1 year after surgery. The authors noted that combined therapy with aspirin and clopidogrel was associated with a significant reduc- tion in the rate of vein graft occlusion as assessed by computed tomography angiography at 1 year (7.4% versus 13.1%, aspirin and clopidogrel versus aspirin alone; P=0.04). Similar findings were reported in a meta-analysis evaluating the role of dual antiplatelet therapy after CABG surgery in which the benefit of combined clopidogrel and aspirin treatment was most pro- nounced after off-pump CABG, reducing vein graft occlusion by 55% compared with aspirin alone.44 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 alterna- tive 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 syn- drome, it is reasonable to administer combination antiplatelet therapy after CABG with aspirin and either prasugrel or ticagrelor (preferred over clopi- dogrel), although prospective clinical trial data from CABG populations are not yet available (Class IIa; Level of Evidence B). 5. 