Wang Zi, Xia Limin, Xu Qing, Ji Qiuyi, Yao Zhifeng, Lv Qianzhou
Department of Clinical Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Transl Med. 2020 Nov;8(21):1341. doi: 10.21037/atm-20-2022b.
To investigate the predictive value of platelet-related microRNAs (miRNAs) for bleeding during and after off-pump coronary artery bypass grafting (OPCABG) and the influence of dual antiplatelet therapy (DAPT) on miRNAs.
This prospective study included 59 patients scheduled for OPCABG. The plasma miR-126 and miR-223 levels were measured and platelet aggregation was determined by thromboelastography during DAPT. The plasma miRNA levels were compared between patients treated with ticagrelor or clopidogrel. Multivariable logistic regression analysis was performed to determine the independent risk factors for bleeding during and after surgery. Active bleeding was defined as a blood loss >1.5 mL/kg/h for 6 consecutive hours within the first 24 hours or in case of reoperation during the first 12 postoperative hours. Severe perioperative bleeding was defined using the universal definition of perioperative bleeding in adult cardiac surgery.
Higher circulating miR-223 levels [odds ratio (OR) =1.348, 95% confidence interval (CI): 1.001-1.814, P=0.047] and lower body mass index (OR =0.648, 95% CI: 0.428-0.980, P=0.040) were independent predictors for severe perioperative bleeding in OPCABG. Ticagrelor treatment led to significant increases in circulating miR-223 levels compared with clopidogrel treatment.
The plasma miR-223 levels served as a predictor for bleeding during and after OPCABG. Circulating miR-223 levels were significantly elevated with ticagrelor treatment compared with clopidogrel treatment. MiR-223 may be a novel biomarker for bleeding in cardiac surgery and can help explain the different efficacies of ticagrelor and clopidogrel.
探讨血小板相关微小核糖核酸（miRNA）对非体外循环冠状动脉旁路移植术（OPCABG）术中及术后出血的预测价值以及双联抗血小板治疗（DAPT）对miRNA的影响。
这项前瞻性研究纳入了59例行OPCABG的患者。在DAPT期间测量血浆miR-126和miR-223水平，并通过血栓弹力图测定血小板聚集情况。比较替格瑞洛或氯吡格雷治疗患者的血浆miRNA水平。进行多变量逻辑回归分析以确定手术期间及术后出血的独立危险因素。活动性出血定义为术后24小时内连续6小时失血>1.5 mL/kg/h或术后12小时内再次手术。围手术期严重出血采用成人心脏手术围手术期出血的通用定义。
较高的循环miR-223水平[比值比（OR）=1.348，95%置信区间（CI）：1.001 - 1.814，P = 0.047]和较低的体重指数（OR = 0.648，95% CI：0.428 - 0.980，P = 0.040）是OPCABG围手术期严重出血的独立预测因素。与氯吡格雷治疗相比，替格瑞洛治疗导致循环miR-223水平显著升高。
血浆miR-223水平可作为OPCABG术中及术后出血的预测指标。与氯吡格雷治疗相比，替格瑞洛治疗使循环miR-223水平显著升高。MiR-223可能是心脏手术出血的新型生物标志物，并有助于解释替格瑞洛和氯吡格雷的不同疗效。
