Janssen P W A, Claassens D M F, Willemsen L M, Bergmeijer T O, Klein P, Ten Berg J M
St. Antonius Center for Platelet Function Research, Nieuwegein, The Netherlands.
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Neth Heart J. 2017 Sep;25(9):482-489. doi: 10.1007/s12471-017-1006-z.
International guidelines do not provide uniform recommendations regarding the use of antiplatelet treatment in the perioperative period in patients undergoing coronary artery bypass grafting (CABG).
A questionnaire was sent to all 16 cardiothoracic centres in the Netherlands to determine which antiplatelet treatment is used in the perioperative setting. Furthermore, a single-centre prospective observational cohort study was performed which included all patients undergoing isolated CABG in July 2014.
Eleven centres responded to the survey. Acetylsalicylic acid monotherapy was discontinued before surgery in 6 centres. In patients with an acute coronary syndrome receiving dual antiplatelet therapy (DAPT), most centres discontinued the P2Y inhibitor preoperatively. DAPT was restarted after surgery in 4 centres. However, 6 centres continued DAPT in patients who had undergone coronary stenting within one month of surgery. In patients with coronary stents, variation in the management of antiplatelet therapy increased in proportion to the interval between stenting and surgery. A total of 70 patients were included in the registry. Acetylsalicylic acid monotherapy was discontinued in 51% of patients and restarted in all patients. P2Y inhibitor treatment was discontinued before surgery in 70% of patients and re-initiated after CABG in 29%.
Major differences were observed in the preoperative and postoperative management of antiplatelet treatment between different Dutch cardiothoracic centres and within a single centre. Part of this variation is probably due to lack of evidence and differences between the current guidelines; however, many of the strategies were not in accordance with any of these guidelines.
国际指南对于冠状动脉旁路移植术（CABG）患者围手术期抗血小板治疗的使用并未提供统一的建议。
向荷兰所有16个心胸外科中心发送了一份调查问卷，以确定围手术期使用哪种抗血小板治疗。此外，开展了一项单中心前瞻性观察队列研究，纳入了2014年7月所有接受单纯CABG的患者。
11个中心回复了调查。6个中心在手术前停用了阿司匹林单药治疗。在接受双联抗血小板治疗（DAPT）的急性冠状动脉综合征患者中，大多数中心在术前停用了P2Y抑制剂。4个中心在术后重新开始使用DAPT。然而，6个中心在术后1个月内接受冠状动脉支架置入术的患者中继续使用DAPT。在有冠状动脉支架的患者中，抗血小板治疗管理的差异随着支架置入与手术间隔时间的延长而增加。登记册共纳入70例患者。51%的患者停用了阿司匹林单药治疗，所有患者均重新开始使用。70%的患者在手术前停用了P2Y抑制剂治疗，29%的患者在CABG术后重新开始使用。
在荷兰不同的心胸外科中心以及单个中心内，抗血小板治疗的术前和术后管理存在重大差异。这种差异部分可能是由于缺乏证据以及当前指南之间的差异；然而，许多策略并不符合任何这些指南。
