Torosian M, Michelson E L, Morganroth J, MacVaugh H
Ann Intern Med. 1978 Sep;89(3):325-8. doi: 10.7326/0003-4819-89-3-325.
We studied 100 consecutive patients to evaluate the potential effect of platelet active and antithrombotic agents prescribed preoperatively on bleeding complications after coronary-artery bypass graft surgery. Preoperative hemostatic values were normal in all patients. Mean mediastinal blood loss was significantly greater in 13 patients taking aspirin (892 +/- 91 ml) and six patients taking Coumadin (warfarin sodium) (858 +/- 168 ml) within 7 days of surgery than in 64 control subjects (439 +/- 28, P less than 0.001). Less marked but similar differences (P less than 0.05) were noted with other agents inhibiting platelet function. However, in nine patients given heparin, mean mediastinal blood loss (436 +/- 61 ml) was no different from that of control subjects. The degree of mediastinal blood loss did not correlate with age, sex, mean total operative time, bypass time, or number of vessels diseased or bypassed. In addition, patients taking aspirin or Coumadin required prolonged chest tube drainage compared to those in heparin or control groups (34 +/- 4 versus 20 +/- 1 h) (P less than 0.001).
我们研究了100例连续患者，以评估术前使用的血小板活性和抗血栓药物对冠状动脉搭桥手术后出血并发症的潜在影响。所有患者术前止血值均正常。在术后7天内，13例服用阿司匹林的患者（892±91ml）和6例服用香豆素（华法林钠）的患者（858±168ml）的平均纵隔失血量明显多于64例对照患者（439±28，P<0.001）。使用其他抑制血小板功能的药物时也观察到不太明显但相似的差异（P<0.05）。然而，9例使用肝素的患者的平均纵隔失血量（436±61ml）与对照患者无异。纵隔失血量的程度与年龄、性别、平均总手术时间、搭桥时间或病变或搭桥血管数量无关。此外，与肝素组或对照组患者相比，服用阿司匹林或香豆素的患者需要更长时间的胸腔引流管引流（34±4小时对20±1小时）（P<0.001）。
