Carrier Michel, Robitaille Danielle, Perrault Louis P, Pellerin Michel, Pagé Pierre, Cartier Raymond, Bouchard Denis
Department of Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
J Thorac Cardiovasc Surg. 2003 Feb;125(2):325-9. doi: 10.1067/mtc.2003.103.
The incidence of heparin-induced thrombocytopenia is increasing, and the thrombin inhibitor danaparoid could be a useful alternative. The objective of the present study was to compare danaparoid and heparin in patients undergoing off-pump coronary artery bypass grafting.
In a prospective, randomized, double-blind clinical trial comparing heparin (bolus of 1 mg/kg) with danaparoid (bolus of 40 U/kg), 71 patients underwent off-pump coronary artery bypass grafting with one of the study drugs. The amount of blood lost, the number of homologous blood products transfused, the troponin T levels, and the amount of anti-Xa activity were monitored.
Thirty-four patients underwent 2.6 +/- 0.7 bypasses with danaparoid, and 37 patients underwent 2.5 +/- 0.9 grafts with heparin (P =.8). Postoperative blood losses averaged 1394 +/- 1033 mL in patients receiving danaparoid and 1130 +/- 868 mL in patients receiving heparin (P =.2). The number of homologous blood products transfused averaged 3.6 +/- 7 units in patients receiving danaparoid and 1.9 +/- 4.4 units in patients receiving heparin (P =.2). The number of patients requiring homologous blood transfusion was higher in patients receiving danaparoid (18/34 [53%]) than in patients receiving heparin (10/37 [27%], P =.03). Serum anti-Xa activity averaged 1.6 +/- 0.6 U/mL in patients receiving danaparoid and 1.9 +/- 0.8 U/mL in patients receiving heparin 30 minutes after injection of the drugs (P =.1) and 0.3 +/- 0.1 and 0.04 +/- 0.08 U/mL, respectively, 12 hours after coronary artery bypass grafting (P =.001). Troponin serum levels were similar 48 hours after coronary artery bypass grafting (0.5 +/- 0.6 and 0.4 +/- 0.6 microg/L, respectively).
Although off-pump coronary artery bypass grafting with danaparoid versus heparin increases the number of patients exposed to homologous blood transfusion (relative risk, 2; 95% confidence limits, 1-4), off-pump coronary artery bypass grafting with danaparoid is a valuable alternative to heparin in patients with thrombocytopenia requiring surgical intervention.
肝素诱导的血小板减少症的发病率正在上升，凝血酶抑制剂达那肝素可能是一种有用的替代药物。本研究的目的是比较达那肝素与肝素在非体外循环冠状动脉旁路移植术患者中的应用。
在一项前瞻性、随机、双盲临床试验中，将肝素（1mg/kg静脉推注）与达那肝素（40U/kg静脉推注）进行比较，71例患者接受了其中一种研究药物的非体外循环冠状动脉旁路移植术。监测失血量、输注的同源血制品数量、肌钙蛋白T水平和抗Xa活性水平。
34例患者使用达那肝素进行了2.6±0.7次旁路移植，37例患者使用肝素进行了2.5±0.9次移植（P = 0.8）。接受达那肝素治疗的患者术后平均失血量为1394±1033mL，接受肝素治疗的患者为1130±868mL（P = 0.2）。接受达那肝素治疗的患者输注的同源血制品平均数量为3.6±7单位，接受肝素治疗的患者为1.9±4.4单位（P = 0.2）。接受达那肝素治疗的患者中需要输注同源血的人数高于接受肝素治疗的患者（18/34 [53%] 对比10/37 [27%]，P = 0.03）。给药30分钟后，接受达那肝素治疗的患者血清抗Xa活性平均为1.6±0.6U/mL，接受肝素治疗的患者为1.9±0.8U/mL（P = 0.1）；冠状动脉旁路移植术后12小时，分别为0.3±0.1和0.04±0.08U/mL（P = 0.001）。冠状动脉旁路移植术后48小时肌钙蛋白血清水平相似（分别为0.5±0.6和0.4±0.6μg/L）。
尽管与肝素相比，使用达那肝素进行非体外循环冠状动脉旁路移植术会增加接受同源输血的患者数量（相对风险为2；95%置信区间为1 - 4），但对于需要手术干预的血小板减少症患者，使用达那肝素进行非体外循环冠状动脉旁路移植术是肝素的一种有价值的替代方法。
