Kayacioglu Ilyas, Gunay Rafet, Saskin Huseyin, Idiz Mustafa, Sensoz Yavuz, Ates Mehmet, Tangurek Burak, Alper Ahmet Taha, Demirtas Mahmut Murat, Yekeler Ibrahim
Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Istanbul, Turkey.
Heart Surg Forum. 2008;11(3):E152-7. doi: 10.1532/HSF98.20071196.
Reactive thrombocytosis has been reported in 20% of patients after coronary artery bypass grafting (CABG), a frequency that might be related to the high incidence of thrombotic complications. The present study was planned to investigate the effect of combined treatment with clopidogrel and acetylsalicylic acid (ASA) on post-CABG reactive thrombocytosis.
Included in this prospective, randomized study were 60 patients who underwent CABG operation with a 6-month follow-up. Three study groups were defined: group 1 (n = 20), a control group of patients who have not developed reactive thrombocytosis after CABG surgery; group 2 (n = 20), patients who have developed reactive thrombocytosis and continue taking ASA (300 mg/day); and group 3 (n = 20), patients who have developed reactive thrombocytosis and continue taking ASA (300 mg/day) with the addition of clopidogrel (75 mg/day).
The mean ages and sex distributions of the patient groups were similar. There were no significant differences between the groups regarding cardiovascular risk factors, baseline laboratory findings, or intraoperative characteristics. Thrombocytosis disappeared within the first month after the operation in both treatment groups. An evaluation of graft patency in the sixth postoperative month revealed that group 2 had significantly more patients with a "positive" result in the exercise test than group 3 and that group 3 had a lower incidence of graft occlusion than group 2 (P < .01).
Combination antiplatelet therapy with ASA and clopidogrel seems to be more effective than ASA alone for maintaining graft patency in patients with reactive thrombocytosis.
冠状动脉旁路移植术（CABG）后20%的患者有反应性血小板增多症的报道，这一发生率可能与血栓形成并发症的高发生率有关。本研究旨在探讨氯吡格雷和乙酰水杨酸（ASA）联合治疗对CABG术后反应性血小板增多症的影响。
本前瞻性随机研究纳入60例行CABG手术且随访6个月的患者。定义了三个研究组：第1组（n = 20），为CABG手术后未发生反应性血小板增多症的对照组患者；第2组（n = 20），发生反应性血小板增多症且继续服用ASA（300毫克/天）的患者；第3组（n = 20），发生反应性血小板增多症且继续服用ASA（300毫克/天）并加用氯吡格雷（75毫克/天）的患者。
各患者组的平均年龄和性别分布相似。在心血管危险因素、基线实验室检查结果或术中特征方面，各组之间无显著差异。两个治疗组术后第一个月内血小板增多症均消失。术后第六个月对移植血管通畅情况的评估显示，第2组运动试验“阳性”结果的患者明显多于第3组，且第3组移植血管闭塞的发生率低于第2组（P <.01）。
对于反应性血小板增多症患者，ASA和氯吡格雷联合抗血小板治疗在维持移植血管通畅方面似乎比单用ASA更有效。
