This protocol is designed to evaluate the effect of antiplatelets (Tirafiban and Prasugrel) on the incidence of early and intermediate graft patency after CABG.

Coronary artery bypass graft (CABG) surgery is a commonly used revascularization strategy in patients with severe coronary artery disease. Saphenous vein grafts (SVGs) are the most frequently used conduits for this procedure. Unlike arterial grafts, SVGs are particularly susceptible to occlusive thrombosis during the first post-operative year, which exposes patients to increased risks of death, myocardial infarction, and repeat revascularization.

This study is designed to evaluate the effect of antiplatelets (Tirafiban and Prasugrel) on the incidence of early and intermediate graft patency after CABG. Patients will undergo planned cardiac Computed tomographic angiography (CTA) predischarge (at 1 week) and CTA/coronary angiography (CAG) at 6 months to 1 year follow-up. CTA at baseline (predischarge) and follow-up CTA/CAG at 6-12 months after CABG will be used to evaluate graft patency.

Inclusion Criteria:

• All comer study where all patients undergoing coronary bypass surgery (CABG) will be randomized to one of the four treatment groups

Exclusion Criteria:

• Acute myocardial infarction (AMI) or cardiogenic shock
• Aortic dissection
• Mechanical valves.
• Contraindication to antiplatelets or aggrastat.
• Active bleeding or high risk of bleeding.
• History of hemorrhagic stroke any time.
• Recent history of embolic stroke or transient ischemic attack (TIA) less than 3 months.
• Active peptic ulcer disease (PUD).
• Liver derangement.
• Warfarin use.
• Heparin-induced thrombocytopenia (HIT) syndrome.
• Thrombocytopenia (platelet count <100,000/mm3), disorders of platelet function