LAUSR

One of the factors affecting the fate of arterial and venous bypass grafts in coronary artery bypass grafting (CABG) is optimal antithrombotic protection. Traditionally, antiplatelet therapy is the treatment of choice to protect grafts against occlusion [1]. Oral anticoagulants have shown to be effective as well [2], but not superior to antiplatelet agents [3]. Therefore, aspirin has become the standard of care in the prevention of graft occlusion [4]. Nowadays, a complicating factor is the use of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 blocker (clopidogrel, prasugrel or ticagrelor) in patients who have recovered from acute coronary syndromes (ACS) [5, 6]. Not only do they have to undergo CABG for their index ACS, they may already be on DAPT when they become eligible for CABG. These considerations make the choice for antithrombotic protection in patients undergoing CABG complex. In this issue of the Netherlands Heart Journal, Janssen et al. present the results of a survey amongst the cardiothoracic centres in the Netherlands on their strategies of perioperative antithrombotic therapy in CABG in the Netherlands [7]. The bottom line is that there is a large variation in the use of antithrombotic therapy around CABG, which was quite similar to the situation 27 years ago [8]. Furthermore, they show the results of a registry in their own centre which actually confirmed the disturbing findings in the rest of the country. The authors correctly conclude that this is due to