Banihashem Nadia, Khorasani Moghadam, Vaffai Hamidreza, Naziri Fereshteh, Khafri Soraya, Seyfi Shahram
Clinical Research Development Unit of Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran.
Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran.
Caspian J Intern Med. 2019 Spring;10(2):156-161. doi: 10.22088/cjim.10.2.156.
Clopidogrel in combination with aspirin increases bleeding, allogeneic red cell transfusion and reoperation rates after CABG. Tranexamic acid, an antifibrinolytic agent, has been approved for use in cardiac surgery to reduce bleeding. In the present study, we evaluated the impact of tranexamic acid on the transfusion and post-operative blood loss after CABG in patients treated with clopidogrel less than 5 days before surgery.
This study was a prospective, randomized, double-blinded clinical trial. Patients undergoing on-pump CABG with their last dose of clopidogrel and aspirin less than 5 days preoperatively were randomly assigned to receive tranexamic acid (10 mg/kg before surgical incision and 10 mg/kg after protamine neutralization) or a corresponding volume of saline solution. The incidence of allogeneic red cell transfusion and 48h postoperative blood loss were recorded.
The average volume of blood loss was 776.92±459.81mL for the TXA group and 1075.00±670.91mL for the control group (P=0.03) in the patients with clopidogrel exposure within 48 h before surgery. The average volume of blood loss was not different between two groups in the patients with clopidogrel exposure within 5 days before surgery and also transfusion rate.
The result of this study shows that tranexamic acid reduced blood loss in the patients with clopidogrel exposure within 48 h before surgery. So, it is better that we use tranexamic acid before surgery in all patients.
氯吡格雷联合阿司匹林会增加冠状动脉旁路移植术（CABG）后的出血、异体红细胞输注和再次手术率。氨甲环酸是一种抗纤维蛋白溶解剂，已被批准用于心脏手术以减少出血。在本研究中，我们评估了氨甲环酸对术前服用氯吡格雷少于5天的CABG患者输血和术后失血的影响。
本研究是一项前瞻性、随机、双盲临床试验。术前最后一剂氯吡格雷和阿司匹林少于5天的接受体外循环CABG的患者被随机分配接受氨甲环酸（手术切口前10mg/kg，鱼精蛋白中和后10mg/kg）或相应体积的生理盐水。记录异体红细胞输注的发生率和术后48小时的失血量。
术前48小时内暴露于氯吡格雷的患者中，氨甲环酸组的平均失血量为776.92±459.81mL，对照组为1075.00±670.91mL（P=0.03）。术前5天内暴露于氯吡格雷的患者两组间平均失血量以及输血率无差异。
本研究结果表明，氨甲环酸可减少术前48小时内暴露于氯吡格雷的患者的失血量。因此，对所有患者在术前使用氨甲环酸更好。
