通过快速周转检测测量的血小板活性可识别出接受氯吡格雷治疗后出血和输血并发症风险增加的冠状动脉旁路移植术患者。

Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.

机构信息

Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Tex.

出版信息

J Thorac Cardiovasc Surg. 2013 Nov;146(5):1259-1266, 1266.e1; discussion 1266. doi: 10.1016/j.jtcvs.2013.06.029. Epub 2013 Aug 13.

DOI:10.1016/j.jtcvs.2013.06.029

PMID:23953984

Abstract

BACKGROUND

We sought to establish a metric for easily estimating bleeding and transfusion risks for cardiac surgery patients after antiplatelet agent use.

METHODS

Deidentified records of patients who underwent coronary artery bypass grafting (CABG) at our institution (January 2010-June 2011) were searched for patients without identified risk factors for excessive bleeding who underwent documented P2Y12 testing after clopidogrel administration (n = 276). Clinical outcomes were analyzed according to whether preoperative platelet function was higher (platelet reactivity units [PRUs], ≥237) or lower (PRU, <237) and according to preoperative PRU cutoffs: high (>290, or no clopidogrel), intermediate (200-290), or low (<200).

RESULTS

Eighty-five patients (57%) received allogeneic blood products at 24 hours or less postoperatively: 33 (22%) received fresh frozen plasma, and 57 (38%) received platelets. The median 12-hour chest tube output (CTO) was 350 mL (interquartile range, 260-490 mL); CTO was "high" (>437 mL) in 62 (42%) of the clopidogrel-treated patients. Lower-PRU patients were more likely to receive coagulation factors (odds ratio [OR], 2.82; P = .0004) and to have high CTO or coagulation factor transfusion (OR, 2.35; P = .02) than higher-PRU patients. Likewise, intermediate- and low-PRU patients had incrementally greater incidences of high CTO (OR, 1.72; P = .002) and coagulation factor transfusion (OR, 2.08; P < .0001) than high-PRU/no clopidogrel patients. High CTO or coagulation factor transfusion was more frequent in intermediate-PRU (OR, 2.67; P = .02) and low-PRU (OR, 5.08; P = .0002) patients than in high-PRU/no clopidogrel patients.

CONCLUSIONS

Among clopidogrel-treated CABG patients, preoperative platelet function testing can identify those at increased risk for postoperative bleeding and transfusion.

摘要

背景

我们旨在建立一种简便的方法，用于评估接受抗血小板药物治疗的心脏手术患者的出血和输血风险。

方法

检索我院（2010 年 1 月至 2011 年 6 月）接受冠状动脉旁路移植术（CABG）患者的无明确出血高危因素且接受氯吡格雷治疗后行血小板功能检测的记录（n=276）。根据术前血小板功能（血小板反应单位[PRU]，≥237）和术前 PRU 切点（高：>290 或无氯吡格雷；中：200-290；低：<200）将患者分为两组，分析临床结局。

结果

85 例（57%）患者术后 24 小时内输注同种异体血液制品：33 例（22%）输注新鲜冰冻血浆，57 例（38%）输注血小板。中位 12 小时胸腔引流量（CTO）为 350ml（四分位距，260-490ml）；氯吡格雷治疗患者中 62 例（42%）的 CTO 较高（>437ml）。低 PRU 患者更可能接受凝血因子（比值比[OR]，2.82；P=.0004）和 CTO 或凝血因子输血（OR，2.35；P=.02），高于高 PRU 患者。同样，中 PRU 和低 PRU 患者的 CTO 较高（OR，1.72；P=.002）和凝血因子输血（OR，2.08；P<.0001）的发生率也逐渐增加，高于高 PRU/无氯吡格雷患者。中 PRU（OR，2.67；P=.02）和低 PRU（OR，5.08；P=.0002）患者的 CTO 或凝血因子输血发生率高于高 PRU/无氯吡格雷患者。