Department of Orthopedics, Shanghai Changhai Hospital, Shanghai, China; Department of Orthopaedics, No. 98 Hospital of PLA, Huzhou, China.
Department of Orthopedics, Shanghai Changzheng Hospital, Shanghai, China.
Pain Physician. 2020 Nov;23(6):E619-E628.
It has been generally recommended that platelet function may recover after the recommended 5-day discontinuation period prior to operation. The technique of thromboelastography has been demonstrated to monitor intraoperative platelet function in liver transplantation and coronary bypass surgery. However, there is a dearth of literature that addresses the utility of thromboelastography in aspirin-treated patients undergoing fusion.
To introduce a functional method of monitoring coagulation and validate the effectiveness of thromboelastography perioperatively in assessing aspirin-treated patients undergoing posterior lumbar fusion.
This research used a retrospective study design.
Orthopedic Department of Changhai Hospital,Shanghai, China and Orthopedic and Anesthesia Department of Changzheng Hospital.
Eighty patients were divided into aspirin-naive and aspirin-treated groups in this study. They had equally undergone lumbar fusion surgery for at least one or more segments between January and June 2018. They matched for age, gender, number of fused segments, and surgical procedures. The coagulation profile, including the reaction time (R), kinetics (K), maximal amplitude (MA), alpha-angle, and coagulation index (CI), platelet inhibition ratio (PIR) was analyzed by thromboelastogram (TEG) prior to operation and on preoperative days 1, 3, and 5. Correlation analysis included parameters such as waiting time, intraoperative blood loss, and postoperative drainage.
Perioperatively, the TEG values including R, K, MA, alpha-angle, and CI, PIR, and correlation analysis showed no significant difference between the 2 groups, respectively (P > 0.05).
First, the relatively small number of patients recruited limits control over other factors; larger studies may need to confirm our findings. Second, the patients were objectively less healthy with more medication treatment, which may result in a variance in the amount of blood loss. Randomized controlled studies are needed to further confirm these results.
TEG may be a helpful method to monitor perioperative platelet function in aspirin-treated patients undergoing fusion. It may be comparatively safe to relax the restriction of the aspirin-discontinued therapeutic window to approximately 2 to 3 days prior to surgery.
一般建议在手术前停止使用推荐的 5 天后，血小板功能可能会恢复。血栓弹力图技术已被证明可在肝移植和冠状动脉搭桥手术中监测术中血小板功能。然而，在接受融合术的阿司匹林治疗患者中，关于血栓弹力图的应用文献却很少。
介绍一种监测凝血功能的方法，并验证血栓弹力图在评估接受后路腰椎融合术的阿司匹林治疗患者围手术期的有效性。
本研究采用回顾性研究设计。
中国上海长海医院骨科和长征医院骨科及麻醉科。
本研究将 80 例患者分为阿司匹林未治疗组和阿司匹林治疗组。他们均在 2018 年 1 月至 6 月期间接受了至少一个或多个节段的腰椎融合术。两组在年龄、性别、融合节段数和手术程序方面相匹配。在术前及术前第 1、3、5 天，通过血栓弹力图（TEG）分析凝血谱，包括反应时间（R）、动力学（K）、最大振幅（MA）、α角和凝血指数（CI）、血小板抑制率（PIR）。相关性分析包括等待时间、术中失血量和术后引流等参数。
围手术期，两组患者的 TEG 值（R、K、MA、α角、CI、PIR）及相关性分析结果差异均无统计学意义（P＞0.05）。
首先，纳入的患者数量相对较少，无法控制其他因素；可能需要更大的研究来证实我们的发现。其次，患者的身体状况较差，需要更多的药物治疗，这可能导致出血量的差异。需要进行随机对照研究来进一步证实这些结果。
TEG 可能是监测接受融合术的阿司匹林治疗患者围手术期血小板功能的一种有用方法。在手术前大约 2 至 3 天放宽阿司匹林停药治疗窗口的限制可能相对安全。
