非体外循环冠状动脉搭桥术治疗调查：非体外循环下氯吡格雷、阿司匹林或两者联合治疗调查。

OPCAB therapy survey: off-pump clopidogrel, aspirin or both therapy survey.

作者信息

D'Ancona G, Donias H W, Karamanoukian R L, Bergsland J, Karamanoukian H L

机构信息

Center for Less Invasive Cardiac Surgery and Robotic Heart Surgery, Kaleida Health, Buffalo General Hospital, Buffalo, NY 14203, USA.

出版信息

Heart Surg Forum. 2001;4(4):354-8.

PMID:11803149

Abstract

BACKGROUND

Standards for heparinization during off-pump coronary artery bypass (OPCAB) are lacking. Similarly, there are no established standards for antiplatelet therapy before or after OPCAB. The aim of this study was to determine current practices and standards for both antiplatelet and heparin therapy in OPCAB.

METHODS

A postal, multiple-choice survey questionnaire was sent to 800 randomly chosen cardiothoracic surgeons in the United States and Canada. Responses were tabulated and analyzed.

RESULTS

The overall response rate was 38% (304 surgeons). The respondents performed CABG in centers with an overall volume between 240 and 1,250 procedures per year (average 380 procedures per year). OPCAB procedures within the same institutions ranged from 20 and 375 cases per year. Sixteen percent (48) of the respondents routinely administer antiplatelet therapy preoperatively; of these, 18% (9) use clopidogrel (Plavix) and 65% (31) aspirin. Eighty-eight percent (267) of the respondents routinely administer antiplatelet therapy after OPCAB. Of these, 24% (65) use clopidogrel and 74% (197) aspirin. Anticoagulation protocols during OPCAB were more variable with 28% (85) administering full dose of heparin, 54% (164) administering half dose heparin, and 13% (40) administering 1/3 dose of heparin during construction of coronary anastomoses. Although 10% (30) maintain an activated clotting time (ACT) above 400 seconds, 70% (213) are content with an ACT above 300 seconds and less than 400 seconds, and 20% (61) responded as "other". The average blood shed postoperatively was 600 ml (range 300 ml and 1 liter). Forty percent (122) administer protamine at half dose, and 60% (182) administer a full dose.

CONCLUSION

Although the vast majority of surgeons use antiplatelet therapy postoperatively, a minority administer preoperative antiplatelet agents for OPCAB. The majority of surgeons use a half dose of heparin during OPCAB with ACT maintained above 300 seconds (> 80%). Prospective studies are necessary to determine the short and intermediate effects of antiplatelet therapy and heparinization doses in OPCAB surgery.

摘要

背景

非体外循环冠状动脉搭桥术（OPCAB）期间的肝素化标准尚缺。同样，OPCAB术前或术后的抗血小板治疗也没有既定标准。本研究的目的是确定OPCAB中抗血小板和肝素治疗的当前实践与标准。

方法

向美国和加拿大随机选取的800名心胸外科医生发送了一份邮政多项选择调查问卷。对回复进行列表并分析。

结果

总体回复率为38%（304名外科医生）。受访者在每年总体手术量为240至1250例（平均每年380例）的中心进行冠状动脉搭桥术（CABG）。同一机构内的OPCAB手术每年为20至375例。16%（48名）受访者术前常规给予抗血小板治疗；其中，18%（9名）使用氯吡格雷（波立维），65%（31名）使用阿司匹林。88%（267名）受访者在OPCAB术后常规给予抗血小板治疗。其中，24%（65名）使用氯吡格雷，74%（197名）使用阿司匹林。OPCAB期间的抗凝方案差异更大，28%（85名）给予全剂量肝素，54%（164名）给予半剂量肝素，13%（40名）在冠状动脉吻合构建期间给予1/3剂量肝素。虽然10%（30名）将活化凝血时间（ACT）维持在400秒以上，但70%（213名）满足于ACT在300秒以上且低于400秒，20%（61名）回答为“其他”。术后平均失血量为600毫升（范围为300毫升至1升）。40%（共122名）给予半剂量鱼精蛋白，60%（共182名）给予全剂量。