冠状动脉旁路移植术时的抗血小板治疗：一项多中心队列研究。

Antiplatelet therapy at the time of coronary artery bypass grafting: a multicentre cohort study.

机构信息

Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Eur J Cardiothorac Surg. 2013 Aug;44(2):e133-40. doi: 10.1093/ejcts/ezt230. Epub 2013 May 9.

DOI:10.1093/ejcts/ezt230

PMID:23660554

Abstract

OBJECTIVES

The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events.

METHODS

A matched-pair analysis was carried out on 6350 consecutive patients undergoing CABG at the three university hospitals in Western Denmark. Patients exposed to aspirin or clopidogrel within 5 days before surgery were compared with those not exposed to these drugs. The data used in the study were retrieved from the Western Denmark Heart Registry.

RESULTS

Of the 6350 patients enrolled, 1846 (29%) had been exposed to aspirin or clopidogrel within 5 days prior to CABG (the APT group). Matching with the remaining 4504 (71%) patients of the control group resulted in 1132 pairs of patients. Patients in the APT group had greater mean chest tube drainage volumes (946 vs 775 ml; P < 0001) and greater transfusion requirements (ranging from 37.4-57.5 vs 29.8%; P < 0.0001) than control group patients. Preoperative aspirin therapy was not associated with greater reoperation rates (4.0 vs 3.9%; P = 0.005); nor was it an independent risk factor for severe postoperative bleeding >1000 ml (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 0.55-1.34). Preoperative clopidogrel use, on the other hand, was associated with greater reoperation rates (10.2 vs 3.9% in the control group; P = 0.005) and was an independent predictor of severe postoperative bleeding (OR: 2.08, 95% CI: 1.55-2.80). Overall, preoperative APT had no significant effect on postoperative 30-day mortality, incidence of myocardial infarction, stroke or need for dialysis.

CONCLUSIONS

Preoperative APT is associated with increased bleeding and greater transfusion requirements after CABG. Clopidogrel exposure is associated with greater reoperation rates and is an independent risk factor for severe postoperative bleeding.

摘要

目的

本多中心队列研究旨在探讨冠状动脉旁路移植术（CABG）时抗血小板治疗（APT）与术后出血并发症、输血需求和不良心血管事件之间的关系。

方法

对丹麦西部三所大学医院的 6350 例连续 CABG 患者进行了配对分析。将术前 5 天内接受阿司匹林或氯吡格雷治疗的患者与未接受这些药物治疗的患者进行比较。研究中使用的数据来自丹麦西部心脏登记处。

结果

在纳入的 6350 例患者中，1846 例（29%）在 CABG 前 5 天内接受过阿司匹林或氯吡格雷治疗（APT 组）。与对照组的 4504 例（71%）患者匹配后，共得到 1132 对患者。APT 组患者的平均胸腔引流量（946 比 775ml；P<0.0001）和输血需求（范围为 37.4-57.5%比 29.8%；P<0.0001）均大于对照组患者。术前阿司匹林治疗与更高的再次手术率无关（4.0%比 3.9%；P=0.005），也不是严重术后出血>1000ml 的独立危险因素（比值比[OR]：1.07，95%置信区间[CI]：0.55-1.34）。另一方面，术前氯吡格雷的使用与更高的再次手术率相关（对照组为 10.2%比 3.9%；P=0.005），并且是严重术后出血的独立预测因子（OR：2.08，95%CI：1.55-2.80）。总的来说，术前 APT 对术后 30 天死亡率、心肌梗死、卒中和透析的发生率没有显著影响。