摘要
目的:探讨不停跳冠脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)术前停用氯吡格雷对围术期出血风险及预后的影响。方法:本研究是一项前瞻性队列研究。纳入接受阿司匹林联合氯吡格雷治疗且拟行OPCABG的患者。根据术前停用氯吡格雷时间分为3组:(1)停药<72 h:(2)停药72~120 h;(3)停药>120 h。主要终点:术后出血量;次要终点:活动性出血发生率;围术期输血情况;围术期脑梗、心梗发生率;30 d死亡率及再入院率。结果:纳入患者358例。停用氯吡格雷<72 h时,患者术后出血量高于停用氯吡格雷>120 h时出血量[317.6 mL(192.0~444.0 mL)vs.247.3 mL(173.0~329.3 mL),P=0.045],活动性出血发生率也高于停用氯吡格雷>120 h时发生率(7.5%vs.0%,P=0.006)。随着停药时间的增加,<72 h、72~120 h、>120 h者围术期脑梗发生率呈增加趋势(1.5%、3.4%、9.3%,P for trend=0.009)。3组在输血情况、心梗发生率、30 d死亡率及再入院率差异无统计学意义。发生不良预后的患者术后出血量及活动性出血发生率高于未发生不良预后的患者。结论:OPCABG术前停用氯吡格雷72~120 h时,出血风险低且预后较好。此外,围术期出血风险与患者短期不良预后相关。
OBJECTIVE To investigate the effects of preoperative clopidogrel withdrawal on perioperative bleeding and short-term prognosis in off-pump coronary artery bypass grafting(OPCABG).METHODS A prospective cohort study was performed including patients receiving aspirin in combination with clopidogrel and scheduled for OPCABG.The patients were divided into three groups according to the withdrawal time of clopidogrel before surgery:(1)<72 h;(2)72-120 h;(3)>120 h.The primary endpoint was blood loss,and the secondary endpoints were active bleeding,blood transfusion,perioperative myocardial infarction and stroke,and 30-day mortality and readmission.RESULTS A total of 358 OPCABG patients were enrolled.The blood loss was significantly higher in patients who discontinued clopidogrel<72 h than that in patients who discontinued clopidogrel>120 h[317.6 mL(192.0-444.0 mL)vs.247.3 mL(173.0-329.3 mL),P=0.045].The incidence of active bleeding was also significantly higher in patients with clopidogrel discontinuation<72 h than that in patients with clopidogrel discontinuation>120 h(7.5%vs.0%,P=0.006).With the extension of discontinuation time of clopidogrel,there was a higher incidence of perioperative stroke(P for trend=0.009).There were no significant differences in the requirement of blood product transfusion,incidences of perioperative myocardial infarction,death and readmission within 30 days after surgery among the three groups.The patients with poor outcomes had higher blood loss volume and a higher risk of active bleeding compared with the patients without poor prognosis.CONCLUSION Patients who discontinue clopidogrel for 72-120 h before OPCABG have lower risk of bleeding and better prognosis.The increased risk of perioperative bleeding is associated with poor short-term outcomes.
作者
王梓
夏利民
李晓烨
邹烨
WANG Zi;XIA Li-min;LI Xiao-ye;ZOU Ye(Department of Pharmacy,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Cardiac Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)
出处
《中国医院药学杂志》
CAS
北大核心
2022年第1期60-64,共5页
Chinese Journal of Hospital Pharmacy
基金
复旦大学附属中山医院青年科学基金(编号:2021ZSQN18)。
作者简介
王梓,男,博士,主管药师,研究方向:抗血小板药物与冠心病;通信作者:邹烨,女,本科,主管药师,研究方向:心血管疾病。
