摘要
目的:分析急诊和限期冠状动脉旁路移植术(CABG)前氯吡格雷停药时间对术后主要出血事件的影响,探索合理的术前氯吡格雷停药时间窗。方法:回顾性纳入2009年至2019年中国医学科学院阜外医院连续收治的急诊及限期行CABG的患者1610例;所有患者规律服用阿司匹林(单抗组,n=222)或阿司匹林和氯吡格雷(双抗组,n=1388)进行抗血小板治疗。所有患者阿司匹林均使用至手术当日,双抗组患者术前氯吡格雷停药时间分为:术前0~3天(n=37)、第4天(n=35)、第5天(n=33)、第6天(n=150)、第7天(n=446)、>7天(n=687)。比较单抗组和双抗组术后出血、栓塞事件及院内死亡率的差异;用Logistic回归分析研究双抗组术前氯吡格雷不同停药时间对术后主要出血事件的影响,根据出血学术研究会(BARC)4型出血标准定义术后主要出血事件。结果:两组在术后24 h胸腔引流量、红细胞、血浆、血小板输注量及再次开胸止血发生率上的差异均无统计学意义(P均>0.05)。双抗组术后院内栓塞事件(0.6%vs.3.6%)和再次心肌梗死发生风险(0.6%vs.2.3%)均明显低于单抗组,差异均有统计学意义(P均<0.05)。多因素Logistic回归分析显示,术前0~3天停用氯吡格雷是术后主要出血事件的危险因素(OR=2.569,95%CI:1.032~6.409,P=0.04),而术前第4天、第5天、第6天、第7天、>7天停药不是术后主要出血事件的危险因素。结论:CABG前停用氯吡格雷3天以上不显著增加术后主要出血事件风险,同时能降低术后总栓塞事件和再次心肌梗死发生风险。
Objectives:To explore the ideal preoperative clopidogrel discontinuation time based on postoperative major bleeding events in patients undergoing acute or selective coronary artery bypass graft(CABG).Methods:Between 2009 and 2019,1610 consecutive patients who underwent acute or selective CABG at Fuwai Hospital were included in this retrospective study.All patients received aspirin alone(AA group,n=222)or dual antiplatelet therapy with aspirin and clopidogrel(AC group,n=1388).Preoperative aspirin therapy was continued until operative day,and patients exposed to dual antiplatelet therapy were stratified into the 6 subgroups according to discontinue time of clopidogrel before CABG(0-3 days,n=37;the fourth day,n=35;the fifth day,n=33;the sixth day,n=150;the seventh day,n=446;>7 days,n=687).The relationship between preoperative clopidogrel discontinuation time and major bleeding events were estimated by multivariable logistic regression models.Major bleeding was defined according to Bleeding Academic Research Consortium(type 4,CABG-related bleeding).Results:There were no significant difference of postoperative bleeding events between AC group and AA group.There were significantly less postoperative myocardial infarction(0.6%vs.2.3%)and embolism events(0.6%vs.3.6%)in AC group than in AA group(both P<0.05).No significant difference of red blood cells,plasma,platelet transfusion,chest tube drainage and thoracotomy hemostasis rate were found between two groups.Clopidogrel discontinuation within 3 days before CABG was associated with significantly increased odds of the major bleeding event(OR=2.569,95%CI:1.032-6.409,P=0.04).No increased odds of major bleeding event were seen in other subgroups.Conclusions:Clopidogrel discontinuation>3 days prior to CABG surgery were not associated with an increased risk of bleeding-related complications,and could reduce postoperative myocardial infarction and embolism events.
作者
刘锐
袁昕
胡盛寿
LIU Rui;YUAN Xin;HU Shengshou(Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第5期423-428,共6页
Chinese Circulation Journal
关键词
急诊
限期
冠状动脉旁路移植术
术前氯吡格雷停药时间
术后主要出血事件
acute
limited
coronary artery bypass graft
preoperative clopidogrel discontinued time
postoperative major bleeding event
