Department of Cardiothoracic Surgery, VA Boston Healthcare System, Boston, Mass, USA.
J Thorac Cardiovasc Surg. 2011 Mar;141(3):782-8. doi: 10.1016/j.jtcvs.2010.09.002. Epub 2010 Dec 13.
Numerous studies have shown that, when using conventional perfusion methodology, patients undergoing coronary artery bypass grafting within 7 days of receiving clopidogrel are at increased risk of bleeding, re-exploration, and blood transfusion. The purpose of this study was to evaluate the effect of clopidogrel administration before coronary artery bypass grafting on patients using thromboresistant surfaces with low-dose heparin during surgical intervention.
Patients who underwent isolated coronary artery bypass grafting between 2005 and 2009 were incorporated in this retrospective study. Of these, 52 (22.2%) received clopidogrel within 5 days before the operation, and 182 (77.8%) did not. Regression models determined the effect of clopidogrel on the rate of chest re-exploration because of bleeding, 24-hour chest tube output, perioperative blood product transfusion, length of stay, morbidity, and perioperative mortality. Hemorrhage-related preoperative risk factors, as well as those found to be significant in univariate models, were included in the multivariate model.
Chest tube drainage was significantly increased during the first 24 hours after the operation in the clopidogrel group (679.7 ± 305.8 vs 516.6 ± 209.8 mL, P = .0007). The need for intraoperative blood product transfusion was similar; nevertheless, more patients receiving clopidogrel required fresh frozen plasma postoperatively (7.7% vs 1.1%, P = .0232). However, risk-adjusted logistic regression showed that exposure to clopidogrel was not a predictor of intraoperative or postoperative blood product transfusion. Lengths of stay in the intensive care unit and hospital were shorter in patients receiving clopidogrel.
Hemostatic complications related to clopidogrel exposure within 5 days before an isolated coronary artery bypass grafting operation can be alleviated by the application of a biocompatible perfusion strategy using low-dose heparin in conjunction with a closed thromboresistant circuit.
大量研究表明，在接受氯吡格雷治疗后 7 天内进行冠状动脉旁路移植术的患者，其出血、再次探查和输血的风险增加。本研究旨在评估在接受低剂量肝素的抗血栓表面进行手术干预时，在冠状动脉旁路移植术前使用氯吡格雷对患者的影响。
本回顾性研究纳入了 2005 年至 2009 年间接受单纯冠状动脉旁路移植术的患者。其中，52 例（22.2%）在手术前 5 天内接受了氯吡格雷治疗，182 例（77.8%）未接受。回归模型确定了氯吡格雷对因出血再次进行胸部探查的比率、24 小时胸腔引流管引流量、围手术期输血量、住院时间、发病率和围手术期死亡率的影响。纳入了与出血相关的术前危险因素以及单变量模型中发现的有统计学意义的因素。
氯吡格雷组术后前 24 小时胸腔引流管引流量显著增加（679.7 ± 305.8 比 516.6 ± 209.8 mL，P =.0007）。术中输血量相似；然而，更多接受氯吡格雷治疗的患者术后需要输注新鲜冰冻血浆（7.7%比 1.1%，P =.0232）。然而，风险调整后的逻辑回归显示，氯吡格雷暴露不是术中或术后输血量的预测因素。接受氯吡格雷治疗的患者在重症监护病房和医院的住院时间较短。
在单独进行冠状动脉旁路移植术前 5 天内使用氯吡格雷可导致止血并发症，使用低剂量肝素和封闭的抗血栓回路的生物相容性灌注策略可缓解这些并发症。
