The trial investigators thereafter performed a post hoc analysis of the 1261 patients who underwent CABG within 7 days of receiv- ing study drug treatment in PLATO. In this CABG subgroup, ticagrelor led to a nonsignificant reduction in the primary end point at 1 year (10.6% versus 13.1%, ticagrelor versus clopi- dogrel; P=0.29) and a significant reduction in cardiovascular mortality (4.1% versus 7.9%, ticagrelor versus clopidogrel; P<0.01). There was no significant difference in CABG-related major bleeding between the randomized treatments.49 On fur- ther review of the causes of death in the CABG subgroup, the mortality reduction with ticagrelor appeared to be related to fewer deaths as a result of cardiovascular, bleeding, and infec- tion complications compared with clopidogrel.51 Although the post hoc analyses of prasugrel and ticagre- lor after surgery are provocative, no prospective, randomized data have yet to become available on their use specifically in the CABG population. This area remains the subject of active research, with ongoing antiplatelet trials evaluating graft patency and clinical events compared with standard isolated aspirin therapy. Off-Pump CABG By avoiding cardiopulmonary bypass, off-pump surgery (off- pump coronary artery bypass [OPCAB]) reduces the systemic inflammatory response after CABG and improves hemostasis by averting the activation and consumption of clotting factors and platelets associated with bypass. However, the clotting disorders and platelet dysfunction induced by cardiopulmo- nary bypass may actually have desirable effects by protecting anastomosis patency and preventing graft thrombosis. 