Reichert Marc G, Robinson Amanda H, Travis Jeffrey A, Hammon John W, Kon Neal D, Kincaid Edward H
Department of Pharmacy, Wake Forest University Baptist Medical Center, School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
Pharmacotherapy. 2008 Feb;28(2):151-5. doi: 10.1592/phco.28.2.151.
To assess the effects of a waiting period after clopidogrel treatment before coronary artery bypass grafting (CABG). Design. Single-center, prospective, observational study.
Cardiothoracic surgery intensive care unit at a university-affiliated medical center.
One hundred consecutive patients who received clopidogrel and were scheduled to undergo primary CABG. In 64 of these patients, CABG was delayed at least 5 days after clopidogrel treatment (group A). The other 36 patients received clopidogrel treatment within 5 days of undergoing CABG (group B).
Data were collected on patient demographics, time of last clopidogrel dose, preoperative anticoagulant and/or antiplatelet agents administered, surgical characteristics, intraoperative transfusions, blood products transfused, and chest tube output for 24 hours after surgery. No significant differences in baseline characteristics or intraoperative variables (number of bypasses, aortic cross-clamp time, and cardiopulmonary bypass time) were noted between the two groups. Mean +/- SD number of packed red blood cell units/patient was 1.1 +/- 1.4 in group A versus 2.1 +/- 2.5 in group B (p=0.009). Mean +/- SD number of platelet units/patient transfused was 0.5 +/- 0.9 in group A versus 1.9 +/- 1.6 in group B (p<0.001). When comparing a subset of 21 patients who received clopidogrel within 72 hours of surgery with the 64 whose CABG was delayed at least 5 days after clopidogrel treatment, the transfusion rates were significantly higher (95% vs 52%, p<0.05). Specifically, the mean +/- SD number of transfused units/patient of red blood cells (3.1 +/- 2.8 vs 1.1 +/- 1.4, p<0.005) and platelets (2.6 +/- 1.5 vs 0.5 +/- 0.9, p<0.007) was greater in patients who received clopidogrel within 72 hours of surgery.
A strategy to delay CABG after clopidogrel treatment led to reduced blood product administration. The optimal waiting period after clopidogrel treatment is not known but appears to be at least 5 days before CABG.
评估冠状动脉旁路移植术（CABG）前氯吡格雷治疗后等待期的影响。设计：单中心、前瞻性观察性研究。
大学附属医院心胸外科重症监护病房。
100例连续接受氯吡格雷治疗并计划行初次CABG的患者。其中64例患者在氯吡格雷治疗后CABG延迟至少5天（A组）。另外36例患者在CABG手术前5天内接受氯吡格雷治疗（B组）。
收集患者人口统计学数据、最后一次氯吡格雷给药时间、术前使用的抗凝剂和/或抗血小板药物、手术特征、术中输血情况、输注的血液制品以及术后24小时胸腔引流管引流量。两组患者的基线特征或术中变量（旁路数量、主动脉阻断时间和体外循环时间）无显著差异。A组患者平均每例输注的浓缩红细胞单位数为1.1±1.4，B组为2.1±2.5（p = 0.009）。A组患者平均每例输注的血小板单位数为0.5±0.9，B组为1.9±1.6（p<0.001）。将21例在手术72小时内接受氯吡格雷治疗的患者与64例在氯吡格雷治疗后CABG延迟至少5天的患者进行比较时，输血率显著更高（95%对52%，p<0.05）。具体而言，手术72小时内接受氯吡格雷治疗的患者平均每例输注的红细胞单位数（3.1±2.8对1.1±1.4，p<0.005）和血小板单位数（2.6±1.5对0.5±0.9，p<0.007）更多。
氯吡格雷治疗后延迟CABG的策略可减少血液制品的使用。氯吡格雷治疗后的最佳等待期尚不清楚，但似乎在CABG前至少5天。
