使用依替巴肽抑制血小板后立即进行冠状动脉搭桥手术：来自PURSUIT研究的结果。不稳定型心绞痛中的血小板糖蛋白IIb/IIIa：使用依替巴肽治疗的受体抑制。

Immediate coronary artery bypass surgery after platelet inhibition with eptifibatide: results from PURSUIT. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrelin Therapy.

作者信息

Dyke C M, Bhatia D, Lorenz T J, Marso S P, Tardiff B E, Hogeboom C, Harrington R A

机构信息

The Sanger Clinic, Charlotte, North Carolina, USA.

出版信息

Ann Thorac Surg. 2000 Sep;70(3):866-71; discussion 871-2. doi: 10.1016/s0003-4975(00)01654-4.

DOI:10.1016/s0003-4975(00)01654-4

PMID:11016325

Abstract

BACKGROUND

The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide.

METHODS

In PURSUIT, 10,948 patients who presented with non-ST segment elevation acute coronary syndromes were prospectively randomized to receive eptifibatide (180 microg/kg bolus plus 2 microg/kg/min infusion) or placebo. A total of 78 patients underwent immediate coronary artery bypass surgery within 2 hours of cessation of study drug (placebo, n = 46; eptifibatide, n = 32). Clinical outcome, bleeding, and transfusion requirements within this subset were examined.

RESULTS

Major bleeding was not different between groups, occurring in 64% of patients receiving placebo and 63% of patients receiving eptifibatide. The incidence of blood transfusion was similar as well (57% vs 59%). Postoperative thrombocytopenia occurred less often after eptifibatide exposure. Perioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46% vs 22%, p < 0.05). There was no difference in perioperative stroke (2.2% vs 6.3%) or mortality (6.3% vs 6.5%).

CONCLUSIONS

Patients may safely undergo coronary artery bypass surgery within 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in the immediate preoperative period had no adverse clinical effects, but did significantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of patients who received eptifibatide, perhaps indicative of a platelet-sparing effect during cardiopulmonary bypass.

摘要

背景

血小板糖蛋白IIb/IIIa抑制剂依替巴肽可改善急性冠脉综合征患者的预后。然而，需要紧急冠状动脉搭桥手术的患者若使用依替巴肽，出血风险可能会增加。对PURSUIT试验的数据进行了回顾，以评估在接触依替巴肽后立即接受冠状动脉手术的患者中的这种风险。

方法

在PURSUIT试验中，10948例非ST段抬高急性冠脉综合征患者被前瞻性随机分为接受依替巴肽（180μg/kg静脉推注加2μg/kg/min输注）或安慰剂。共有78例患者在停用研究药物后2小时内接受了冠状动脉搭桥手术（安慰剂组，n = 46；依替巴肽组，n = 32）。检查了该亚组患者的临床结局、出血情况和输血需求。

结果

两组之间的大出血情况无差异，接受安慰剂的患者中有64%发生大出血，接受依替巴肽的患者中有63%发生大出血。输血发生率也相似（57%对59%）。依替巴肽暴露后术后血小板减少症的发生率较低。接受依替巴肽的患者围手术期心肌梗死明显减少（46%对22%，p<0.05）。围手术期卒中（2.2%对6.3%）或死亡率（6.3%对6.5%）无差异。