Shim Jae Kwang, Choi Yong Seon, Oh Young Jun, Bang Sou Ouk, Yoo Kyung Jong, Kwak Young Lan
Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea.
J Thorac Cardiovasc Surg. 2007 Jul;134(1):59-64. doi: 10.1016/j.jtcvs.2007.03.013.
Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting.
One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively.
Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups.
Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.
在接受体外循环冠状动脉搭桥手术的患者中，术前使用氯吡格雷和阿司匹林会显著增加术后出血。非体外循环冠状动脉搭桥术已被提议作为一种替代技术，以减少与氯吡格雷相关的术后出血。本研究旨在确定阿司匹林和氯吡格雷治疗对非体外循环冠状动脉搭桥术围手术期失血和输血需求的影响。
106例计划行非体外循环冠状动脉搭桥术的患者被分为三组：术前6天以上停用阿司匹林和氯吡格雷（第1组，n = 35）；阿司匹林和氯吡格雷持续使用至术前3至5天（第2组，n = 51）；两种药物在手术2天内持续使用（第3组，n = 20）。在麻醉诱导前分析血栓弹力图描记。在手术前后测量常规凝血指标。手术期间使用细胞回收装置，并回输回收的血液。术后记录胸腔引流管引流量和输血需求。
各组患者的特征、手术数据和血栓弹力图描记相似。所有组术后血细胞比容水平和血小板计数均显著下降，凝血酶原时间延长，组间无差异。各组围手术期失血量和输血量均相似。
对于择期行非体外循环冠状动脉搭桥术的患者，即使在手术2天内使用氯吡格雷和阿司匹林进行预处理，也不会增加围手术期失血量和输血需求。
