The authors noted similar graft patency between patients who received clopidogrel after surgery (86.5%) and those who To summarize the published data, 3 meta-analyses have assessed the potential benefits of dual antiplatelet therapy after CABG, presenting mixed results. In the largest meta-analysis on the subject involving 5 ran- domized trials and 6 observational studies including >25000 patients, dual antiplatelet therapy was found to reduce vein On the other hand, another review came to the opposite con- clusion, stating that combination antiplatelet therapy has not been demonstrated to improve graft patency.45 Although there is some suggestion that adding clopidogrel to aspirin may improve postoperative vein graft patency, that effect appears to be most pronounced after off-pump CABG.44 46 Dual anti- platelet therapy was also found to significantly increase the risk of major bleeding after surgery.44 Whereas controversy remains concerning clopidogrel use after CABG, 2 new agents have recently been introduced, increasing the number of therapeutic options available for postoperative platelet inhibition. Like clopidogrel, both prasu- grel and ticagrelor inhibit the platelet P2Y12 adenosine diphos- phate receptor, but they have a more rapid onset of action and more consistent and pronounced platelet inhibition than clopi- Prasugrel was first evaluated in the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis in Myocardial Infarction 38 (TRITON-TIMI 38) study, in which 13608 patients presenting with acute coronary syndromes were ran- domized to receive aspirin plus clopidogrel 75 mg daily or aspirin plus prasugrel 10 mg daily for 6 to 15 months. 