Waldron Nathan H, Dallas Torijaun, Erhunmwunsee Loretta, Wang Tracy Y, Berry Mark F, Welsby Ian J
Department of Anesthesiology, Duke University Medical Center, Durham, NC, 27710, USA.
Department of Anesthesiology, San Antonio Military Medical Center, Fort Sam Houston, TX, 78234, USA.
J Thromb Thrombolysis. 2017 Feb;43(2):194-202. doi: 10.1007/s11239-016-1441-5.
Antiplatelet use for treatment of coronary artery disease (CAD) is common amongst thoracic surgery patients. Perioperative management of antiplatelet agents requires balancing the opposing risks of myocardial ischemia and excessive bleeding. Perioperative bridging with short-acting intravenous antiplatelet agents has shown promise in preventing myocardial ischemia, but may increase bleeding. We sought to determine whether perioperative bridging with eptifibatide increased bleeding associated with thoracic surgery. After Institutional Review Board approval, we identified thoracic surgery patients receiving eptifibatide at our institution (n = 30). These patients were matched 1:2 with control patients with CAD who did not receive eptifibatide from an institutional database of general thoracic surgery patients. The primary endpoint for our study was the number of units of blood transfused perioperatively. There were no differences in our primary endpoint, number of units of blood products transfused. There were also no differences noted between groups in intraoperative blood loss, chest tube duration, or postoperative length of stay (LOS). While there were no difference noted in overall complications, including our outcome of perioperative MI or death, composite cardiovascular events were more common in the eptifibatide group. In our retrospective exploratory analysis, eptifibatide bridging in patients with high-risk or recent PCI was not associated with an increased need for perioperative transfusion, bleeding, or increased LOS. In addition, we found a similar rate of perioperative mortality or myocardial infarction in both groups, though the ability of eptifibatide to protect against perioperative myocardial ischemia is unclear given different baseline CAD characteristics.
抗血小板药物用于治疗冠状动脉疾病（CAD）在胸外科手术患者中很常见。围手术期抗血小板药物的管理需要平衡心肌缺血和过度出血这两种相反的风险。使用短效静脉抗血小板药物进行围手术期桥接在预防心肌缺血方面显示出前景，但可能会增加出血风险。我们试图确定使用依替巴肽进行围手术期桥接是否会增加胸外科手术相关的出血。经机构审查委员会批准后，我们在本机构中确定了接受依替巴肽治疗的胸外科手术患者（n = 30）。这些患者与未接受依替巴肽治疗的CAD对照患者按1:2的比例进行匹配，对照患者来自一个普通胸外科手术患者的机构数据库。我们研究的主要终点是围手术期输注的血液单位数。在我们的主要终点，即输注的血液制品单位数方面没有差异。两组在术中失血量、胸管留置时间或术后住院时间（LOS）方面也没有差异。虽然在总体并发症方面没有差异，包括我们的围手术期心肌梗死或死亡结果，但依替巴肽组的复合心血管事件更为常见。在我们的回顾性探索性分析中，高危或近期接受过PCI的患者使用依替巴肽桥接与围手术期输血需求增加、出血或住院时间延长无关。此外，我们发现两组的围手术期死亡率或心肌梗死发生率相似，不过鉴于不同的CAD基线特征，依替巴肽预防围手术期心肌缺血的能力尚不清楚。
