Coronary artery bypass graft (CABG) procedures face challenges related to graft failure, driven by factors such as acute thrombosis, neointimal hyperplasia, and atherosclerotic plaque formation. Despite extensive efforts over four decades, the optimal antithrombotic strategy to prevent graft occlusion while minimizing bleeding risks remains uncertain, relying heavily on expert opinions rather than definitive guidelines. To address this uncertainty, we conducted a review of randomized clinical trials and meta-analyses of antithrombotic therapy for patients with CABG. These studies examined various antithrombotic regimens in CABG such as single antiplatelet therapy (aspirin or P2Y₁₂ inhibitors), dual antiplatelet therapy, and anticoagulation therapy. We evaluated outcomes including the patency of grafts, major adverse cardiovascular events, and bleeding complications and also explored future perspectives to enhance long-term outcomes for CABG patients. Early studies established aspirin as a key component of antithrombotic pharmacotherapy after CABG. Subsequent randomized controlled trials focused on adding a P2Y₁₂ inhibitor (such as clopidogrel, ticagrelor, or prasugrel) to aspirin, yielding mixed results. This article aims to inform clinical decision-making and guide the selection of antithrombotic strategies after CABG.

冠状动脉旁路移植术 (CABG) 手术面临与移植失败相关的挑战，这些挑战是由急性血栓形成、新生内膜增生和动脉粥样硬化斑块形成等因素驱动的。尽管四十年来做出了广泛的努力，但防止移植物闭塞同时最大限度地降低出血风险的最佳抗血栓策略仍然不确定，很大程度上依赖于专家意见而不是明确的指南。为了解决这一不确定性，我们对 CABG 患者的抗血栓治疗的随机临床试验和荟萃分析进行了回顾。这些研究考察了 CABG 中的各种抗血栓治疗方案，例如单一抗血小板治疗（阿司匹林或 P2Y ₁₂抑制剂）、双重抗血小板治疗和抗凝治疗。我们评估了包括移植物通畅性、主要不良心血管事件和出血并发症在内的结局，并探讨了提高 CABG 患者长期结局的未来前景。早期研究确定阿司匹林是 CABG 后抗血栓药物治疗的关键成分。随后的随机对照试验重点关注在阿司匹林中添加 P2Y ₁₂抑制剂（如氯吡格雷、替格瑞洛或普拉格雷），结果好坏参半。本文旨在为临床决策提供参考，并指导 CABG 后抗血栓策略的选择。