Filsoufi Farzan, Rahmanian Parwis B, Castillo Javier G, Kahn Ronald A, Fischer Gregory, Adams David H
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY 10029, USA.
J Cardiothorac Vasc Anesth. 2008 Feb;22(1):60-6. doi: 10.1053/j.jvca.2007.10.009. Epub 2007 Dec 31.
An increasing number of patients are referred for coronary artery bypass graft surgery while treated with clopidogrel. This agent inhibits the platelet P2Y12 adenosine-5'-diphosphate (ADP) receptor, which results in an inhibition of platelet aggregation. The aim of this study was to determine the effect of preoperative clopidogrel treatment on postoperative bleeding, mortality, and morbidity in patients after coronary artery bypass graft surgery.
Retrospective cohort study.
University hospital (single institution).
One hundred forty-four patients who underwent isolated coronary artery bypass graft surgery.
Seventy-two patients who received clopidogrel during the preoperative period formed the study group. Seventy-two patients (matched based on age, sex, and preoperative risk profile) served as the control group.
Clopidogrel-treated patients received significantly more platelet (4.4 +/- 5.7 v 1.3 +/- 3.2 U, p < 0.001) and red blood cell (5.1 +/- 4.2 v 2.6 +/- 2.6 U, p < 0.001) transfusions compared with the control group. All-cause mortality and morbidity were significantly higher in clopidogrel-treated patients (n = 7, 9% v n = 1, 1%; p = 0.031). In addition, the lengths of stay in the intensive care unit and the hospital were significantly longer in these patients (2.5 +/- 2.7 v 1.4 +/- 0.9 days, p = 0.002; 9.9 +/- 11 v 6 +/- 2.5 days, p = 0.003). Despite an increased morbidity in the clopidogrel group, the midterm survival was similar between the 2 groups (1-year and 5-year survival 97% +/- 2% and 95.7% +/- 3% v 100% +/- 0% and 87% +/- 10%, respectively; p = 0.885).
Preoperative clopidogrel is associated with increased transfusion requirement after coronary artery bypass graft surgery. The present data suggest that all-cause mortality and major morbidity may also increase in these patients. In clopidogrel-treated patients, coronary artery bypass graft surgery should be delayed in the absence of specific medical indications as recommended by recent American Heart Association guidelines.
越来越多接受氯吡格雷治疗的患者被转诊进行冠状动脉旁路移植术。该药物抑制血小板P2Y12腺苷-5'-二磷酸（ADP）受体，从而抑制血小板聚集。本研究的目的是确定术前氯吡格雷治疗对冠状动脉旁路移植术后患者术后出血、死亡率和发病率的影响。
回顾性队列研究。
大学医院（单一机构）。
144例行单纯冠状动脉旁路移植术的患者。
72例术前接受氯吡格雷治疗的患者组成研究组。72例患者（根据年龄、性别和术前风险特征匹配）作为对照组。
与对照组相比，接受氯吡格雷治疗的患者接受血小板（4.4±5.7单位对1.3±3.2单位，p<0.001）和红细胞（5.1±4.2单位对2.6±2.6单位，p<0.001）输血的次数明显更多。接受氯吡格雷治疗的患者全因死亡率和发病率明显更高（n = 7，9%对n = 1，1%；p = 0.031）。此外，这些患者在重症监护病房和医院的住院时间明显更长（2.5±2.7天对1.4±0.9天，p = 0.002；9.9±11天对6±2.5天，p = 0.003）。尽管氯吡格雷组发病率增加，但两组的中期生存率相似（1年和5年生存率分别为97%±2%和95.7%±3%对100%±0%和87%±10%；p = 0.885）。
术前氯吡格雷与冠状动脉旁路移植术后输血需求增加有关。目前的数据表明，这些患者的全因死亡率和主要发病率也可能增加。对于接受氯吡格雷治疗的患者，如美国心脏协会近期指南所建议，在无特定医学指征的情况下，应推迟冠状动脉旁路移植术。
