Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
University Hospital Center Mostar, University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina.
Thorac Cardiovasc Surg. 2021 Oct;69(7):630-638. doi: 10.1055/s-0039-1693122. Epub 2019 Jul 30.
This study sought to determine (1) the association between the length of preoperative clopidogrel discontinuation, blood loss, and transfusion requirements and (2) whether preoperative platelet function testing predicts excessive postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) surgery.
In this retrospective analysis, patients undergoing CABG were divided into three groups with regard to the period between preoperative clopidogrel cessation and surgery: group 1 ( = 94, ≤3 days), group 2 ( = 100, 4-5 days), and group 3 ( = 83, 6-7 days), respectively. Impedance aggregometry (Multiplate) with arachidonic acid (ASPI) test assay (used for platelets stimulation) and adenosine diphosphate (ADP) test (used for platelets stimulation) was performed before the surgery. Primary outcome was 24 hours chest tube output (CTO) and transfusion requirements (red blood cell concentrate [RBCC], platelet concentrate [PC], fibrinogen concentrate [FC], and fresh-frozen plasma [FFP]) were considered as secondary outcomes.
CTO during 24 hours was significantly higher in group 1 as compared with groups 2 and 3, respectively ( = 0.003). Considering secondary outcomes, RBCC ( = 0.043), PC ( = 0.001), FC ( = 0.003), and FFP ( = 0.010) were more frequently transfused in group 1 as compared with groups 2 and 3, respectively. Multiple electrode aggregometry ASPI and ADP tests were significantly correlated with the 24-hour CTO (ASPI test-rho = -0.258, < 0.001; ADP test-rho = -0.164, = 0.007). A significant correlation was observed between clopidogrel-free interval and 24-hour CTO (rho = -0.200, < 0.001). Receiver-operating characteristics (ROC) curve analysis revealed cutoff values to delineate bleeding tendency (ASPI test ≤ 25 area under the aggregation curve [AUC], ADP test ≤63 AUC, and clopidogrel-free interval ≤3 days).
Excessive postoperative bleeding occurred less frequently if the period between clopidogrel discontinuation and surgery was longer than 3 days, as compared with shorter waiting time. Inadequate recovery of the platelets function following clopidogrel cessation in preoperative period was associated with increased bleeding risk. Platelet function testing was found to be a useful tool for postoperative bleeding management in our hands.
本研究旨在确定（1）术前氯吡格雷停药时间、出血量和输血需求之间的关系，以及（2）术前血小板功能检测是否预测行冠状动脉旁路移植术（CABG）的患者术后过度出血。
在这项回顾性分析中，根据术前氯吡格雷停药与手术之间的时间，将接受 CABG 的患者分为三组：组 1（ = 94，≤3 天）、组 2（ = 100，4-5 天）和组 3（ = 83，6-7 天）。在术前进行了阻抗聚集（Multiplate）用花生四烯酸（ASPI）试验（用于血小板刺激）和二磷酸腺苷（ADP）试验（用于血小板刺激）。主要结局为 24 小时胸腔引流量（CTO），输血需求（红细胞浓缩物[RBCC]、血小板浓缩物[PC]、纤维蛋白原浓缩物[FC]和新鲜冷冻血浆[FFP]）被视为次要结局。
与组 2 和组 3 相比，组 1 的 24 小时 CTO 明显更高（ = 0.003）。考虑到次要结局，与组 2 和组 3 相比，组 1 更频繁地输注 RBCC（ = 0.043）、PC（ = 0.001）、FC（ = 0.003）和 FFP（ = 0.010）。多电极聚集 ASPI 和 ADP 试验与 24 小时 CTO 呈显著相关（ASPI 试验-rho = -0.258， < 0.001；ADP 试验-rho = -0.164， = 0.007）。氯吡格雷停药时间与 24 小时 CTO 呈显著相关（rho = -0.200， < 0.001）。受试者工作特征（ROC）曲线分析显示，出血倾向的截断值为（ASPI 试验 ≤ 25 聚集曲线下面积[AUC]，ADP 试验 ≤63 AUC，氯吡格雷停药时间 ≤3 天）。
与较短的等待时间相比，如果氯吡格雷停药与手术之间的时间超过 3 天，则术后过度出血发生的频率较低。术前氯吡格雷停药后血小板功能恢复不足与出血风险增加有关。在我们的手中，血小板功能检测被发现是一种用于术后出血管理的有用工具。
