Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
Circ Cardiovasc Interv. 2012 Aug 1;5(4):590-6. doi: 10.1161/CIRCINTERVENTIONS.112.968313. Epub 2012 Jun 26.
Controversy exists regarding the optimal preventative therapy for venous thromboembolism (VTE) after coronary artery bypass graft (CABG) surgery. We sought to compare the effectiveness and safety of the most commonly used regimens.
We assembled a cohort of 92 699 patients who underwent CABG between 2004 and 2008, using the Premier database. Patients were categorized by method of VTE prevention initiated within 48 hours of surgery, including no preventative therapy (n=55 400), mechanical preventative therapy (n=21 162), subcutaneous unfractio--nated or low-molecular-weight heparin (n=10 718), subcutaneous fondaparinux (n=88), and concurrent mechanical-chemical therapy (n=5331). The incidence of VTE and major bleeding events within 6 weeks of CABG were compared, using multivariable and propensity score adjustment. The overall incidence of VTE for the entire cohort was 0.74%, and the incidence of major bleeding was 1.43%. VTE and bleeding events occurred with similar incidence in each of the patient categories (VTE: 0.70%, 0.79%, 0.81%, 1.14%, and 0.73%; major bleeding: 1.36%, 1.45%, 1.69%, 3.41%, 1.50%; no prevention, mechanical prevention, subcutaneous heparin, subcutaneous fondaparinux, concurrent mechanical-chemical prevention, respectively). Compared with receiving no prevention, the use of mechanical prevention or subcutaneous heparin did not significantly reduce the risk of VTE or change the risk of major bleeding (P=NS).
Venous thromboembolism occurs infrequently after CABG. Compared with the use of no prevention, the administration of chemical or mechanical preventative therapies to CABG patients does not appreciably lower the risk of VTE. These data provide support for the common practice of administering no VTE preventative therapy after CABG, used for nearly 60% of patients within this cohort.
关于冠状动脉旁路移植术（CABG）后静脉血栓栓塞症（VTE）的最佳预防治疗存在争议。我们旨在比较最常用方案的有效性和安全性。
我们使用 Premier 数据库，对 2004 年至 2008 年间接受 CABG 的 92699 例患者进行了队列研究。根据术后 48 小时内开始的 VTE 预防方法，将患者分为以下几类：无预防治疗（n=55400）、机械预防治疗（n=21162）、皮下未分馏或低分子肝素（n=10718）、皮下磺达肝素（n=88）和同时进行机械-化学治疗（n=5331）。使用多变量和倾向评分调整比较 CABG 后 6 周内 VTE 和大出血事件的发生率。整个队列的 VTE 总发生率为 0.74%，大出血发生率为 1.43%。在每个患者类别中，VTE 和出血事件的发生率相似（VTE：0.70%、0.79%、0.81%、1.14%和 0.73%；大出血：1.36%、1.45%、1.69%、3.41%、1.50%；无预防、机械预防、皮下肝素、皮下磺达肝素、同时进行机械-化学预防）。与未接受预防治疗相比，使用机械预防或皮下肝素并不能显著降低 VTE 的风险，也不会改变大出血的风险（P=NS）。
CABG 后 VTE 很少发生。与不进行预防治疗相比，CABG 患者接受化学或机械预防治疗并不能显著降低 VTE 的风险。这些数据为近 60%的患者不进行 VTE 预防治疗的常见做法提供了支持。
