These results are hypothesis-generating and should be confirmed in larger studies. For patients who are intolerant of Ticagrelor,- clopidogrel or prasugrel should be considered. In the POPular CABG study we investigate if the addition of ticagrelor, a drug that inhibits blood platelets from clotting, to treatment with aspirin will reduce the rate of saphenous vein graft occlusion as assessed with coronary computed tomography angiography at 1 year after coronary artery bypass grafting surgery. Introduction Ticagrelor is a more potent platelet inhibitor than clopidogrel but also has a more rapid offset of inhibitory effect. Thus, by using a lower dose of aspirin in this study, vein graft patency in the control arm may be lower than observed in clinical practice. WARNING: (A) BLEEDING RISK, (B) ASPIRIN DOSE AND Ticagrelor EFFECTIVENESS. We prospectively compared the efficacy of ticagrelor and aspirin after CABG. A. Ticagrelor was associated with a higher rate of major bleeding unrelated to CABG surgery including higher rates of fatal intracranial bleeding compared with clopidogrel. Ticagrelor is recommended for the treatment of acute coronary syndromes and ESC guidelines recommend the use of ticagrelor in patients undergoing CABG for ACS. NB Ticagrelor should be given to this patient group regardless of any revascularisation strategy. The researchers found that the rates of saphenous vein graft patency were 88.7, 82.8, and 76.5 percent, respectively, with ticagrelor + aspirin, ticagrelor alone, and aspirin alone at one year post-CABG. This is an important trial, but there are several caveats. Conclusions: Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. In the ONSET/OFFSET study of patients with stable coronary artery disease, ticagrelor’s effects dissipated within 48–120 hours of discontinuation. Trial registration number NCT01373411: Results. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG. Saphenous vein graft patency rates 1 year post-CABG were 88.7% (432 of 487 vein grafts) with ticagrelor + aspirin; 82.8% (404 of 488 vein grafts) with ticagrelor alone; and 76.5% (371 of 485 vein grafts) with aspirin alone. Conclusions Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. The optimal timing of discontinuation of ticagrelor prior to coronary artery bypass graft (CABG) surgery is unknown. BLEEDING RISK. A randomized controlled trial comparing ticagrelor vs. aspirin monotherapy for 12 months in patients after coronary artery bypass grafting (CABG). Routinely, patients post-CABG receive 81-325 mg aspirin for 1 year, with most operators using 325 mg daily to preserve vein graft patency. These results are hypothesis-generating and should be confirmed in larger studies. The usual strategy of ceasing anti-platelet therapy 7 days prior to CABG still applies. Ticagrelor should be given for 12 months post CABG. Aims: The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing coronary artery bypass grafting (CABG) is unclear. Methods and results: We randomly assigned in double-blind fashion patients scheduled for CABG to either ticagrelor 90 mg twice daily … Surgery including higher rates of fatal intracranial bleeding compared with clopidogrel is recommended for treatment! 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