Rahe-Meyer Niels, Winterhalter Michael, Hartmann Julia, Pattison Albert, Hecker Hartmut, Calatzis Andreas, Solomon Cristina
Department of Anesthesiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
Anesth Analg. 2008 Dec;107(6):1791-7. doi: 10.1213/ane.0b013e3181865733.
Platelet dysfunction due to antiplatelet therapy contributes to perioperative bleeding. Several trials investigating the influence of aspirin intake within the 5 days before surgery reported that transfusion requirements were either increased or not significantly affected by aspirin intake. Our objective was to compare the assessment of aspirin intake by patient self-reporting and by measurement of platelet function with regard to transfusion requirements.
In a prospective trial, a standardized questionnaire was used in 100 patients for aspirin intake within the 5 days immediately before coronary artery bypass grafting. Whole blood platelet aggregation triggered by arachidonic acid was investigated using the Multiplate platelet function analyzer.
Eleven of 23 patients with aspirin intake within the 5 days before the intervention showed an abnormal aggregation response. Nine of 77 patients who reported no aspirin intake before surgery had an abnormal aggregation response. There were no significant differences in chest tube drainage and red blood cell transfusion over the first 24 h postoperatively between patients with and without reported aspirin intake. There was no significant difference in chest tube drainage over the first 24 h postoperatively between patients showing normal or abnormal aggregation response. Patients with abnormal aggregation before intervention (<51 U) received significantly more platelet transfusion than patients with normal aggregation (1.1 U compared to 0.3 U, P = 0.001).
Our results suggest that arachidonic acid-induced aggregation in whole blood may be a better predictor of platelet-related coagulopathy and platelet transfusion than the assessment of aspirin intake by patient self-reporting.
抗血小板治疗导致的血小板功能障碍会引起围手术期出血。多项研究手术前5天内服用阿司匹林影响的试验报告称，输血需求要么增加，要么不受阿司匹林服用的显著影响。我们的目的是比较通过患者自我报告评估阿司匹林服用情况和通过测量血小板功能评估阿司匹林服用情况对输血需求的影响。
在一项前瞻性试验中，对100例即将接受冠状动脉搭桥手术的患者使用标准化问卷询问其术前5天内的阿司匹林服用情况。使用多电极血小板功能分析仪研究花生四烯酸引发的全血血小板聚集情况。
在干预前5天内服用阿司匹林的23例患者中，有11例显示出异常的聚集反应。在术前报告未服用阿司匹林的77例患者中，有9例显示出异常的聚集反应。报告服用阿司匹林和未服用阿司匹林的患者术后最初24小时内的胸管引流量和红细胞输注量无显著差异。聚集反应正常和异常的患者术后最初24小时内的胸管引流量无显著差异。干预前聚集反应异常（<51 U）的患者比聚集反应正常的患者接受的血小板输注显著更多（分别为1.1 U和0.3 U，P = 0.001）。
我们的结果表明，与通过患者自我报告评估阿司匹林服用情况相比，花生四烯酸诱导的全血聚集可能是血小板相关凝血病和血小板输注更好的预测指标。
