Objective To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery.
Design Systematic review and network meta-analysis.
Data sources Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019.
Eligibility criteriafor selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery.
Main outcome measures The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death.
Results This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates.
Conclusions The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes.
Study registration PROSPERO registration number CRD42017065678.

目的评估不同口服抗血栓药物对冠状动脉搭桥手术患者预防大隐静脉移植失败的作用。
设计系统的审查和网络荟萃分析。
数据来源： Medline，Embase，Web of Science，CINAHL和Cochrane图书馆从成立到2019年1月25日。选择研究的
资格标准接受口服抗血栓药物（抗血小板或抗凝剂）预防的参与者（≥18岁）的随机对照试验大隐静脉移植术后冠状动脉搭桥术失败。主要观察指标
主要疗效终点为大隐静脉移植失败，主要安全终点为大出血。次要终点是心肌梗塞和死亡。
结果该评价确定了3266篇文献引用，与21篇与20项随机对照试验相关的文章被纳入网络荟萃分析。这20项试验由4803名参与者组成，调查了9种不同的干预措施（8种有效干预和1种安慰剂）。中度确定性证据支持使用双重抗血小板疗法与阿司匹林加替卡格雷（赔率0.50，95％置信区间0.31至0.79，需要治疗的数字10）或阿司匹林加氯吡格雷（0.60，0.42至0.86，19）减少隐隐与阿司匹林单一疗法相比，静脉移植失败。该研究发现，没有强有力的证据表明不同抗血栓治疗方法在主要出血，心肌梗塞和死亡方面存在差异。不能排除不及物的可能性；然而，在所有纳入的分析中，试验间的异质性和不连贯性都很低。使用每个移植物数据进行的敏感性分析并没有改变效果的估计。
结论该网络荟萃分析的结果表明，在阿司匹林中加入替卡格雷或氯吡格雷预防冠状动脉旁路移植术后大隐静脉移植失败具有绝对的重要意义。手术后的双重抗血小板治疗应根据患者情况调整药物干预的安全性和有效性，并与重要的患者预后相平衡。
研究注册PROSPERO注册编号CRD42017065678。