Antithrombotic Therapy After Coronary Artery Bypass Grafting Combined With Coronary Endarterectomy

This study investigates the best antithrombotic (blood-thinning) regimen after a combined heart surgery: coronary artery bypass grafting (CABG) plus coronary endarterectomy (CE). CABG is the standard bypass surgery for blocked heart arteries, but when arteries are severely diseased throughout their length (diffuse disease), surgeons sometimes need to perform an endarterectomy — surgically cleaning out the diseased inner lining of the artery. This combination surgery is effective but carries a higher risk of clotting in the newly cleaned vessels, and the optimal medication regimen afterward is poorly defined. Eligible participants are adult patients with diffuse coronary artery disease who undergo CE+CABG during the study period, with no contraindications to either dual antiplatelet therapy (aspirin + clopidogrel) or warfarin anticoagulation. Patients with high bleeding risk (HAS-BLED score ≥3), valve surgery at the same time, emergency procedures, severe kidney or liver disease, prior bleeding history, hemorrhagic stroke history, or drug allergies to trial medications are excluded. Participants are randomized to different antithrombotic regimens and followed for graft patency, major adverse cardiac events, and bleeding complications. The research matters because the wrong blood thinning regimen after this complex surgery can mean either a clotted bypass graft and another heart attack, or life-threatening bleeding — getting this balance right could save lives.