Department of Surgery, Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Ann Thorac Surg. 2011 Dec;92(6):1971-6. doi: 10.1016/j.athoracsur.2011.07.052. Epub 2011 Oct 5.
Management of patients requiring antiplatelet therapy with clopidogrel (Plavix) and major lung resection must balance the risks of bleeding and cardiovascular events. We reviewed our experience with patients treated with clopidogrel perioperatively to examine outcomes, including results of a new strategy for high-risk patients.
Patients who underwent major lung resection and received perioperative clopidogrel between January 2005 and September 2010 were reviewed. Initially, clopidogrel management consisted of discontinuation approximately 5 days before surgery and resumption immediately after surgery. After July 2010, high-risk patients (drug-eluting coronary stent placement within prior year or previous coronary event after clopidogrel discontinuation) were admitted 2 to 3 days preoperatively and bridged with the intravenous glycoprotein IIb/IIIa receptor inhibitor eptifibatide (Integrilin) according to a multidisciplinary cardiology/anesthesiology/thoracic surgery protocol. Outcomes were compared with control patients (matched for preoperative risk factors and extent of pulmonary resection) who did not receive perioperative clopidogrel.
Fifty-four patients who had major lung resection between January 2005 and September 2010 and received clopidogrel perioperatively were matched with 108 control subjects. Both groups had similar mortality, postoperative length of stay, and no differences in the rates of perioperative transfusions, reoperations for bleeding, myocardial infarctions, and strokes. Seven of the 54 clopidogrel patients were admitted preoperatively for an eptifibatide bridge. Two of these patients received perioperative transfusions, but there were no deaths, reoperations, myocardial infarctions, or stroke.
Patients taking clopidogrel can safely undergo major lung resection. Treatment with an eptifibatide bridge may minimize the risk of cardiovascular events in higher risk patients.
需要氯吡格雷（Plavix）抗血小板治疗并接受肺切除术的患者，其管理必须平衡出血和心血管事件的风险。我们回顾了接受围手术期氯吡格雷治疗的患者的经验，以检查包括高风险患者新策略结果在内的预后。
回顾 2005 年 1 月至 2010 年 9 月期间接受肺切除术并接受围手术期氯吡格雷治疗的患者。最初，氯吡格雷管理包括在手术前约 5 天停药，并在手术后立即恢复。2010 年 7 月后，高危患者（一年内接受药物洗脱冠状动脉支架置入术或氯吡格雷停药后发生冠状动脉事件）在术前 2 至 3 天住院，并根据多学科心脏病学/麻醉学/胸外科协议，用静脉注射糖蛋白 IIb/IIIa 受体抑制剂依替巴肽（Integrilin）桥接。结果与未接受围手术期氯吡格雷治疗的对照患者（匹配术前危险因素和肺切除术范围）进行比较。
2005 年 1 月至 2010 年 9 月期间，54 例接受肺切除术且接受围手术期氯吡格雷治疗的患者与 108 例对照患者相匹配。两组患者的死亡率、术后住院时间以及围手术期输血、因出血再次手术、心肌梗死和中风的发生率均无差异。54 例氯吡格雷患者中有 7 例在术前入院接受依替巴肽桥接。这 2 例患者接受了围手术期输血，但无死亡、再次手术、心肌梗死或中风。
服用氯吡格雷的患者可以安全地接受肺切除术。用依替巴肽桥接治疗可能会降低高危患者心血管事件的风险。
