Kincaid Edward H, Monroe Michelle L, Saliba David L, Kon Neal D, Byerly Wesley G, Reichert Marc G
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Ann Thorac Surg. 2003 Jul;76(1):124-8; discussion 128. doi: 10.1016/s0003-4975(03)00190-5.
We examined the effects of preoperative administration of enoxaparin (ENOX), a low-molecular-weight heparin, on bleeding indices and transfusion rates in patients undergoing coronary artery bypass grafting (CABG).
Patients undergoing isolated CABG between 1997 and 2002 who received preoperative ENOX or a continuous infusion of unfractionated heparin (UFH) were randomly divided into three groups: continuous UFH, ENOX last administered more than 12 hours before surgery (ENOX > 12), and ENOX administered less than 12 hours before surgery (ENOX < 12). Perioperative hemoglobin values, transfusion rates, and bleeding complications were compared.
A total of 69, 58, and 34 patients comprised the UFH, ENOX > 12, and ENOX < 12 groups, respectively. Preoperative demographics and hematologic data were similar among the groups. Compared with the UFH group, the ENOX < 12 group had significantly lower postoperative hemoglobin values (9.6 +/- 1.3 g/dL versus 10.4 +/- 1.2 g/dL, p < 0.05), higher transfusion rates (73.5% versus 50.7%, p < 0.05), and required more total packed red cells per patient (882 +/- 809 mL versus 472 +/- 626 mL, p < 0.05). A nonsignificant increase was noted in the risk of returning to the operating room for bleeding in patients who had received ENOX compared with patients receiving UFH (6.5% versus 2.9%).
The preoperative use of ENOX less than 12 hours before CABG is associated with lower postoperative hemoglobin values and higher rates of transfusion than continuous UFH.
我们研究了术前给予低分子量肝素依诺肝素（ENOX）对接受冠状动脉旁路移植术（CABG）患者出血指标和输血率的影响。
1997年至2002年间接受单纯CABG且术前接受ENOX或持续输注普通肝素（UFH）的患者被随机分为三组：持续UFH组、术前12小时以上给予ENOX组（ENOX > 12）和术前12小时内给予ENOX组（ENOX < 12）。比较围手术期血红蛋白值、输血率和出血并发症。
UFH组、ENOX > 12组和ENOX < 12组分别有69例、58例和34例患者。各组术前人口统计学和血液学数据相似。与UFH组相比，ENOX < 12组术后血红蛋白值显著降低（9.6±1.3 g/dL对10.4±1.2 g/dL，p < 0.05），输血率更高（73.5%对50.7%，p < 0.05），且每位患者所需的总浓缩红细胞更多（882±809 mL对472±626 mL，p < 0.05）。与接受UFH的患者相比，接受ENOX的患者因出血返回手术室的风险有非显著性增加（6.5%对2.9%）。
CABG术前12小时内使用ENOX与术后血红蛋白值较低和输血率高于持续使用UFH有关。
