READERS’ COMMENTS Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting: Does Off/On-Pump Play a Role? We read the systematic review by Nocerino et al1 discussing the effect of postoperative dual antiplatelet therapy (DAPT) on graft patency after coronary artery bypass grafting (CABG). We had earlier presented a pooled analysis of 11 studies (both observational and randomized controlled trials) evaluating the benefit of DAPT after CABG.2 We have also presented results specifically in patients undergoing offpump CABG (OPCABG). A recent study has presented an ad hoc analysis of the Randomized On/Off Bypass (ROOBY) trial.3 The ROOBY study is a randomized controlled trial comparing on- and OPCABG.4 Although they conclude that DAPT does not affect graft patency in the overall cohort, they found improvement in graft patency in multivariate analysis in patients treated with DAPT who underwent OPCABG (p ¼ 0.014). We conducted an updated meta-analysis of the 3 published randomized controlled trials3,5,6 incorporating only patients who underwent OPCABG. This demonstrated the significant benefit of DAPT (risk ratio for graft occlusion with DAPT 0.50, 95% confidence interval 0.42 to 0.60, p