冠状动脉旁路移植术和心脏瓣膜置换术后华法林联合阿司匹林或氯吡格雷的单中心出血比较。
A Single-Center Bleeding Comparison of Warfarin Plus Aspirin or Clopidogrel Following Coronary Artery Bypass Grafting and Surgical Valve Replacement.
机构信息
Department of Pharmacy, 6915Mayo Clinic, Rochester, MN, USA.
Department of Quantitative Health Sciences, 6915Mayo Clinic, Rochester, MN, USA.
出版信息
Clin Appl Thromb Hemost. 2023 Jan-Dec;29:10760296231156175. doi: 10.1177/10760296231156175.
The optimal antithrombotic therapy following combined coronary artery bypass graft (CABG) and surgical valve replacement (SVR) surgery remains unclear. The aim of this single-center, retrospective cohort study was to assess the safety and effectiveness of a vitamin K antagonist (VKA) plus either aspirin or clopidogrel in patients following combined CABG and SVR. The primary endpoint was the occurrence of bleeding within six months. The secondary endpoint was the occurrence of CV death, stroke, acute coronary syndrome (ACS), or valve dysfunction. Outcomes were identified by pre-specified ICD codes. A total of 629 patients were included in the analysis, with 583 patients receiving aspirin and 46 patients receiving clopidogrel. Bleeding occurred in 1.7% of patients receiving aspirin and in 0% of patients receiving clopidogrel (p = 0.99). CV death, stroke, ACS, or valve dysfunction occurred in 3.1% of patients receiving aspirin and 4.3% of patients receiving clopidogrel (p = 0.65). In this study, there were no differences in the safety or effectiveness of a VKA plus either aspirin or clopidogrel following combined CABG and SVR.
联合冠状动脉旁路移植术（CABG）和心脏瓣膜置换术（SVR）后最佳的抗血栓治疗方案仍不明确。本单中心回顾性队列研究旨在评估维生素 K 拮抗剂（VKA）联合阿司匹林或氯吡格雷在联合 CABG 和 SVR 术后患者中的安全性和有效性。主要终点为 6 个月内出血的发生情况。次要终点为心血管死亡、卒中和急性冠状动脉综合征（ACS）或瓣膜功能障碍的发生情况。通过预先指定的 ICD 编码来识别结果。共纳入 629 例患者，其中 583 例患者接受阿司匹林治疗，46 例患者接受氯吡格雷治疗。接受阿司匹林治疗的患者中有 1.7%发生出血，接受氯吡格雷治疗的患者中无出血发生（p=0.99）。接受阿司匹林治疗的患者中有 3.1%发生心血管死亡、卒中和 ACS，或瓣膜功能障碍，接受氯吡格雷治疗的患者中有 4.3%发生心血管死亡、卒中和 ACS，或瓣膜功能障碍（p=0.65）。在这项研究中，联合 CABG 和 SVR 后，VKA 联合阿司匹林或氯吡格雷的安全性和有效性没有差异。
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