Ferraris Victor A, Bolanos Michael D
Division of Cardiothoracic & Vascular Surgery, Chandler Medical Center, University of Kentucky, Lexington, Kentucky.
Division of Cardiothoracic & Vascular Surgery, Chandler Medical Center, University of Kentucky, Lexington, Kentucky.
Semin Thorac Cardiovasc Surg. 2014 Autumn;26(3):223-30. doi: 10.1053/j.semtcvs.2014.09.005. Epub 2014 Oct 23.
Unfortunately, venous bypass grafts still have a prominent role in operative coronary revascularization (coronary artery bypass graft [CABG]). Venous grafts develop pathologically occlusive disease that limits the effectiveness of CABG, and antiplatelet drugs following operation may limit this problem. The types and indications of antiplatelet drugs following CABG generate some controversy in the recent literature. This review surveys relevant evidence about the use of antiplatelet drugs following CABG to identify the controversial issues, define appropriate questions, and attempt to provide evidence-based interventions that may be helpful in limiting graft occlusion after CABG. Evidence suggests that, in most CABG patients, dual antiplatelet drugs (aspirin and clopidogrel), given after operation, minimizes early (within 1 year) graft failure and improves intermediate-term outcomes, better than single antiplatelet therapy with aspirin alone. There are gaps in the knowledge base that supports this contention, and future clinical trials will likely augment or alter this recommendation.
不幸的是，静脉搭桥移植物在冠状动脉血运重建手术（冠状动脉旁路移植术[CABG]）中仍发挥着重要作用。静脉移植物会发生病理性闭塞性疾病，这限制了冠状动脉旁路移植术的有效性，术后使用抗血小板药物可能会缓解这一问题。冠状动脉旁路移植术后抗血小板药物的类型和适应证在近期文献中引发了一些争议。本综述调查了冠状动脉旁路移植术后使用抗血小板药物的相关证据，以识别争议问题、明确恰当的问题，并尝试提供基于证据的干预措施，这可能有助于减少冠状动脉旁路移植术后的移植物闭塞。有证据表明，在大多数冠状动脉旁路移植术患者中，术后给予双联抗血小板药物（阿司匹林和氯吡格雷）可将早期（1年内）移植物失败率降至最低，并改善中期预后，优于单独使用阿司匹林的单联抗血小板治疗。支持这一观点的知识库存在空白，未来的临床试验可能会补充或改变这一建议。
