Schaefer Andreas, Sill Bjoern, Schoenebeck Jeannette, Schneeberger Yvonne, Kubik Mathias, Reichenspurner Hermann, Gulbins Helmut
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Interact Cardiovasc Thorac Surg. 2016 Feb;22(2):136-40. doi: 10.1093/icvts/ivv296. Epub 2015 Oct 29.
To evaluate the effect of Ticagrelor on intra- and postoperative bleeding complications in patients undergoing coronary bypass surgery.
For this study, patients who underwent on-pump or off-pump coronary bypass surgery with preoperative acetylsalicylic acid (ASA) and Ticagrelor administration, between January 2014 and December 2014, were included. In the matched control group, continued dual antiplatelet therapy (DAPT) consisted of Clopidogrel and ASA. A total of 28 consecutive patients (24 males; 73 ± 6.6 years) with preoperative Ticagrelor intake underwent elective (n = 22), urgent (n = 2) or emergency (n = 4) cardiac bypass surgery. The postoperative blood loss, red blood cell units given and intra- and postoperative bleeding complications were documented. To evaluate the effect of Ticagrelor treatment on bleeding during and after coronary bypass surgery in a non-randomized study, we used a case-matched analysis.
Baseline parameters showed no important differences between the study group and the control group regarding the matching variables, left ventricular function, preoperative clinical status and risk stratification. The preoperative laboratory analysis showed no important differences regarding coagulation and blood cell count parameters. Overall blood loss was significantly higher in the study group with a mean loss of 1028.8 ± 735.5 ml (P = 0.0002). Accordingly, units of red blood cells administered were also significantly higher in the study group (P = 0.0002). In the Ticagrelor group, there were six rethoracotomies due to postoperative bleeding with a blood loss of more than 1200 ml in the first 3 h. With no rethoracotomies in the Clopidogrel group, this also showed statistical significance for the postoperative course (P = 0.02). There were no differences found regarding ICU stay and ventilation time. Comparing the mean hospital stay, the study group presented a significantly longer stay than the control group (P = 0.001).
Recent studies about bleeding complications in patients with Ticagrelor intake undergoing CABG in a real-life scenario presented inconsistent data. We were able to show in a case-matched analysis that Ticagrelor administration leads to significantly higher blood loss, more red blood cell units transfused and a higher rate of rethoracotomies. The data also present a longer hospital stay to the disadvantage of the study group. Consequently, Ticagrelor intake before CABG procedures should be avoided or at least discontinued 3 days before cardiac surgery.
评估替格瑞洛对接受冠状动脉搭桥手术患者术中和术后出血并发症的影响。
本研究纳入了2014年1月至2014年12月期间接受体外循环或非体外循环冠状动脉搭桥手术且术前服用阿司匹林（ASA）和替格瑞洛的患者。在匹配对照组中，持续双联抗血小板治疗（DAPT）由氯吡格雷和ASA组成。共有28例连续的术前服用替格瑞洛的患者（24例男性；73±6.6岁）接受了择期（n = 22）、急诊（n = 2）或紧急（n = 4）心脏搭桥手术。记录术后失血量、输注的红细胞单位数量以及术中和术后出血并发症情况。为了在非随机研究中评估替格瑞洛治疗对冠状动脉搭桥手术期间及术后出血的影响，我们采用了病例匹配分析。
关于匹配变量、左心室功能、术前临床状态和风险分层，研究组与对照组之间的基线参数无重要差异。术前实验室分析显示，在凝血和血细胞计数参数方面无重要差异。研究组的总体失血量显著更高，平均失血量为1028.8±735.5毫升（P = 0.0002）。相应地，研究组输注的红细胞单位数量也显著更高（P = 0.0002）。在替格瑞洛组中，有6例因术后出血在最初3小时内失血超过1200毫升而进行了二次开胸手术。氯吡格雷组无二次开胸手术，这在术后过程中也显示出统计学意义（P = 0.02）。在重症监护病房（ICU）停留时间和通气时间方面未发现差异。比较平均住院时间，研究组的住院时间明显长于对照组（P = 0.001）。
近期关于在现实生活场景中服用替格瑞洛的患者行冠状动脉旁路移植术（CABG）出血并发症的研究呈现出不一致的数据。我们通过病例匹配分析能够表明，服用替格瑞洛会导致失血量显著增加、输注的红细胞单位数量更多以及二次开胸手术率更高。数据还显示研究组的住院时间更长。因此，应避免在冠状动脉搭桥手术前服用替格瑞洛，或者至少在心脏手术前3天停用。
