Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico S. Donato, Milan, Italy.
Ann Thorac Surg. 2011 Jan;91(1):123-9. doi: 10.1016/j.athoracsur.2010.09.022.
Preoperative treatment with thienopyridines is associated with increased postoperative bleeding in cardiac surgery patients. Patients under treatment with thienopyridines have different levels of platelet dysfunction and the effects of discontinuation are not totally predictable. The present study aimed to determine if a preoperative assessment of platelet function in these patients could provide clinically relevant information regarding the risks of excessive postoperative bleeding and transfusion requirements.
This is a retrospective analysis of prospectively collected data. Patients (n=87) under thienopyridine treatment until at least one week before cardiac surgery were enrolled in the study. Platelet function was assessed preoperatively with multiple electrode aggregometry: the adenosine diphosphate (ADP) test and TRAP (thrombin receptor-associated peptide) test were performed for all patients.
Univariate analysis revealed that postoperative bleeding was associated (p<0.1) with preoperative serum creatinine level, platelet count, CPB (cardiopulmonary bypass) duration, and results from the ADP test and the TRAP test. Multivariable linear regression analysis confirmed the CPB duration (p=0.049) and ADP test (p=0.007) as independently associated with postoperative bleeding. The relationship between the ADP test and postoperative bleeding was investigated with polynomial regression analysis, and a logarithmic equation provided the best fit. The accuracy of prediction was good (area under the curve 0.71, p=0.013), with a cutoff value for the ADP test at 31 U (sensitivity 72%, specificity 66%, negative predictive value 92%, and positive predictive value 29%).
The multiple electrode aggregometry ADP test in patients under thienopyridine treatment and undergoing cardiac surgery is associated with postoperative bleeding and platelet transfusion and provides an accurate preoperative prediction of postoperative bleeding risk.
噻吩吡啶类药物的术前治疗与心脏手术患者的术后出血增加有关。接受噻吩吡啶类药物治疗的患者血小板功能障碍程度不同，停药的效果也不完全可预测。本研究旨在确定这些患者术前血小板功能评估是否能提供与术后过度出血和输血需求相关的临床相关信息。
这是一项前瞻性收集数据的回顾性分析。研究纳入了至少在心脏手术前一周开始接受噻吩吡啶类药物治疗的 87 名患者。所有患者均进行术前多电极聚集法血小板功能评估：进行二磷酸腺苷（ADP）试验和血栓素受体相关肽（TRAP）试验。
单因素分析显示，术后出血与术前血清肌酐水平、血小板计数、体外循环（CPB）持续时间以及 ADP 试验和 TRAP 试验结果相关（p<0.1）。多变量线性回归分析证实 CPB 持续时间（p=0.049）和 ADP 试验（p=0.007）与术后出血独立相关。用多项式回归分析研究 ADP 试验与术后出血的关系，对数方程提供了最佳拟合。预测的准确性较好（曲线下面积为 0.71，p=0.013），ADP 试验的截断值为 31 U（灵敏度为 72%，特异性为 66%，阴性预测值为 92%，阳性预测值为 29%）。
接受噻吩吡啶类药物治疗并接受心脏手术的患者的多电极聚集法 ADP 试验与术后出血和血小板输注相关，并能准确预测术后出血风险。
