Comparing High and lOw-dose asPirin With Dual anTIplatelet Therapy for Three Months Using prasUgrel and aSpirin Following Coronary Artery Bypass Grafting. (OPTIMUS-CABG Trial)

Exclusion Criteria20

• Cardiogenic shock
• Patients with recent acute coronary syndrome (ACS) (\<12 months)
• Single vessel CABG
• Patients with preoperative atrial fibrillation
• Dialysis
• Thrombocytopenia (platelet count \< 100 000 platelets/uL)
• Anemia (Hemoglobin level \< 10 g/dL)
• Severe liver failure Child-Pugh classification \>4
• Known, active infections with HIV, HBV, HCV, tuberculosis
• Active malignant disease or history of malignancy within the past 5 years
• Indication for DAPT (e.g. recent PCI or ACS or recent stents of peripheral arteries)
• Indication for oral anticoagulant treatment 13 Indications for the use of methotrexate at a dose of 15 mg/week or more
• \. Any contraindication for prasugrel or ASA 15. Planned additional cardiac or non-cardiac surgery within 12 months 16. Non-cardiac co-morbidity with life expectancy less than 12 months 17. History of any bleeding complications due to the use of DAPT 18. History of intracranial bleeding 19. History of gastro-intestinal bleeding 20. Pregnancy or breastfeeding 21. Lack of compliance with the use of a highly effective method of birth control 22. Planned coronary endarterectomy 23. Severe impaired renal function (eGFR \<40mL/min/1.73 m2).
• Perioperative cardiogenic shock
• Intraoperative death or death prior randomization
• Myocardial infarction within 12-24 hours following CABG or prior randomization
• Ischemic or hemorrhagic stroke within 12-24 hours following CABG or prior randomization
• Any postoperative complication that may increase patients' risk with DAPT
• Atrial Fibrillation prior randomization
• Gastro-intestinal bleeding prior randomization