Badreldin Akmal, Kroener Axel, Kamiya Hiroyuki, Lichtenberg Artur, Hekmat Khosro
Department of Cardiothoracic Surgery, University of Jena, Germany.
Interact Cardiovasc Thorac Surg. 2010 Jan;10(1):48-52. doi: 10.1510/icvts.2009.211805. Epub 2009 Oct 22.
The effect of antiplatelet therapy (APT) on postoperative bleeding, transfusion needs and re-exploration remains unclear. This study examines the influence of APT, as well as antiplatelet mono- and combined therapy, on haemorrhage and transfusion requirements in patients undergoing coronary artery bypass on cardiopulmonary bypass (CPB). Six hundred and fifty patients were reviewed retrospectively, 325 patients received APT within seven days and 325 control patients. APT group had two subgroups: clopidogrel (CLO) group: n=48 patients received CLO as mono-therapy; combined group: n=277 patients received both CLO and aspirin (ASS). The mediastinal drainage at 12 h was control group: 505 ml+/-445 ml and APT group: 802 ml+/-720 ml, P<0.001. APT group (vs. control group) received significantly more units of blood (3.9+/-4.2 vs. 1.9+/-2.6; P<0.001), platelet units (1.0+/-1.4 vs. 0.1+/-0.3; P<0.001), and fresh frozen plasma (FFP) units (2.9+/-3.9 vs. 0.9+/-2.2; P<0.001), respectively. Combined and mono-therapy groups had no significant differences in bleeding and blood transfusion. Considerations should be given to delaying elective coronary surgery for patients received APT for seven days.
抗血小板治疗（APT）对术后出血、输血需求及再次手术探查的影响仍不明确。本研究探讨了APT以及抗血小板单药治疗和联合治疗对接受体外循环（CPB）冠状动脉搭桥术患者出血及输血需求的影响。对650例患者进行回顾性分析，325例患者在7天内接受了APT治疗，325例为对照组。APT组分为两个亚组：氯吡格雷（CLO）组：48例患者接受CLO单药治疗；联合治疗组：277例患者接受CLO和阿司匹林（ASS）联合治疗。12小时纵隔引流量对照组为505 ml±445 ml，APT组为802 ml±720 ml，P<0.001。APT组（与对照组相比）接受的血液单位显著更多（3.9±4.2比1.9±2.6；P<0.001）、血小板单位（1.0±1.4比0.1±0.3；P<0.001）以及新鲜冰冻血浆（FFP）单位（2.9±3.9比0.9±2.2；P<0.001）。联合治疗组和单药治疗组在出血和输血方面无显著差异。对于接受APT治疗7天的患者，应考虑延迟择期冠状动脉手术。
