Chemtob Raphaelle Avigael, Moeller-Soerensen Hasse, Holmvang Lene, Olsen Peter Skov, Ravn Hanne Berg
Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
Department of Cardiothoracic Anaesthesiology, Rigshospitalet, Copenhagen, Denmark.
J Cardiothorac Vasc Anesth. 2017 Apr;31(2):569-574. doi: 10.1053/j.jvca.2016.10.007. Epub 2016 Oct 11.
Outcome in patients with acute coronary syndrome (ACS) is improved with dual antiplatelet therapy (DAPT). Patients with acute aortic dissection type A (AAD) often present with similar symptoms and may therefore be prescribed DAPT before diagnosis. The aim of this study was to evaluate the use of antiplatelet therapy (APT) prior to AAD surgery and patient outcome, including indications according to the European Society of Cardiology's (ESC) recent guidelines.
A retrospective, observational study.
A tertiary University Hospital, Rigshospitalet, Heart Centre, Copenhagen, Denmark.
The study included 171 patients operated for AAD during 2010 to 2014.
The independent relationship of preoperative APT was explored on 30-day mortality, intraoperative bleeding and perioperative transfusion requirements. Furthermore, the indications for APT were obtained.
Patients receiving APT (n = 73) did not have an increased 30-day mortality (29% v 20%, p = 0.18). However, APT increased intraoperative bleeding by 45% (p<0.001) and increased perioperative transfusion of red blood cells by 71%, fresh frozen plasma by 52%, and platelets by 56% (p = 0.002). Among patients receiving APT preoperatively, 26 patients received acetylsalicylic acid (ASA) alone and 46 patients received DAPT. Bleeding was significantly more pronounced in patients receiving DAPT (5.6±4.1 L), compared to ASA alone (3.6±3.1 L) and no APT (3.3±4.8 L) (p<0.001). However, there was no significant difference in mortality between groups. DAPT, including ticagrelor, increased intraoperative bleeding by 62% compared to DAPT with clopidogrel (p = 0.004). Among patients receiving DAPT, only 30% of the patients fulfilled ESC criteria for ACS treatment.
The use of APT was associated with increased intraoperative bleeding and transfusion requirement; however, it was not associated with a statistically significant increased mortality. Only a minority of patients fulfilled ESC criteria for ACS treatment with DAPT.
双联抗血小板治疗（DAPT）可改善急性冠状动脉综合征（ACS）患者的预后。急性A型主动脉夹层（AAD）患者常表现出相似症状，因此可能在诊断前就接受了DAPT治疗。本研究的目的是评估AAD手术前抗血小板治疗（APT）的使用情况及患者预后，包括根据欧洲心脏病学会（ESC）最新指南的适应证。
一项回顾性观察研究。
丹麦哥本哈根里格霍斯医院心脏中心三级大学医院。
本研究纳入了2010年至2014年间接受AAD手术的171例患者。
探讨术前APT与30天死亡率、术中出血及围手术期输血需求之间的独立关系。此外，获取APT的适应证。
接受APT治疗的患者（n = 73）30天死亡率未增加（29%对20%，p = 0.18）。然而，APT使术中出血量增加了45%（p<0.001），围手术期红细胞输注量增加了71%，新鲜冰冻血浆输注量增加了52%，血小板输注量增加了56%（p = 0.002）。在术前接受APT治疗的患者中，26例仅接受阿司匹林（ASA）治疗，46例接受DAPT治疗。与仅接受ASA治疗（3.6±3.1 L）和未接受APT治疗（3.3±4.8 L）的患者相比，接受DAPT治疗的患者出血明显更严重（5.6±4.1 L）（p<0.001）。然而，各组之间的死亡率无显著差异。与使用氯吡格雷的DAPT相比，包括替卡格雷在内的DAPT使术中出血量增加了62%（p = 0.004）。在接受DAPT治疗的患者中，只有30%的患者符合ESC的ACS治疗标准。
APT的使用与术中出血量增加和输血需求增加相关；然而，与统计学上显著增加的死亡率无关。只有少数患者符合ESC的DAPT治疗ACS的标准。
