术前血小板功能障碍患者手术心肌血运重建术的早期临床结果

IF 0.2 4区医学 Q4 MEDICINE, GENERAL & INTERNAL

Vojnosanitetski pregled Pub Date : 2023-01-01 DOI:10.2298/vsp230306036s

V. Stojiljković, Aleksandar Kamenov, M. Lazarević, M. Golubovic, Velimir Perić, M. Stosic, S. Živić, D. Milic

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Subjects were divided in four groups: Control (arachidonic acid-dependent PLT aggregation - ASPI) ? 790 AU/min, adenosine diphosphate (ADP) ? 406 AU/min, Mild acetylsalicylic acid - ASA (ASPI 410-789 AU/min), Pronounced ASA (ASPI ? 409 AU/min) and dual APT (DAPT) (ASPI ? 789 AU/min; ADP ? 405 AU/min). Preoperative data, intraoperative characteristics and postoperative outcomes were obtained and compared between groups. Results. A significant difference was found regarding the average time of APT cessation between groups (p < 0.001). DAPT group had significantly higher drainage compared to Control group (p = 0.004), Mild ASA group (p = 0.001) and compared to Pronounced ASA group (p = 0.006). Pronounced ASA group had significantly higher rate of chest reexploration compared to Mild ASA group (p = 0.032). DAPT group required significantly more packed red blood cells (PRBC) compared to Control group (p < 0.001) and Mild ASA group (p = 0.009). Pronounced ASA group received significantly more PRBC compared to Control group (p < 0.001) and Mild ASA group (p = 0.019). DAPT group required higher amounts of PLT compared to Control group (p < 0.001), Mild ASA group (p = 0.002) and Pronounced ASA group (p < 0.001). DAPT group received higher amounts of cryoprecipitate compared to Control group (p = 0.002), Mild ASA group (p = 0.009) and Pronounced ASA group (p = 0.016). Conclusion. 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引用次数: 0

摘要

背景/目的。冠状动脉旁路移植术(CABG)是相当一部分缺血性心脏病患者的治疗选择。一些术后并发症与术前抗血小板治疗(APT)密切相关。本研究的目的是比较血小板功能保留患者(PLT)和血小板功能受损患者(APT残留治疗效果)CABG的早期临床结果。这项前瞻性、非随机、观察性研究共纳入181例孤立性冠脉搭桥患者。受试者分为四组:对照组(花生四烯酸依赖性PLT聚集- ASPI) ?790 AU/min，二磷酸腺苷(ADP) ?406 AU/min，轻度乙酰水杨酸- ASA (ASPI 410-789 AU/min)，读作ASA (ASPI ?409 AU/min)和双APT (DAPT) (ASPI ?789 AU /分钟;ADP吗?405 AU /分钟)。获取两组术前资料、术中特征及术后结果进行比较。结果。两组间平均停药时间差异有统计学意义(p < 0.001)。DAPT组引流明显高于对照组(p = 0.004)、轻度ASA组(p = 0.001)和重度ASA组(p = 0.006)。重度ASA组胸部再探查率明显高于轻度ASA组(p = 0.032)。与对照组(p < 0.001)和轻度ASA组(p = 0.009)相比，DAPT组需要更多的红细胞(PRBC)。重度ASA组的PRBC明显高于对照组(p < 0.001)和轻度ASA组(p = 0.019)。与对照组(p < 0.001)、轻度ASA组(p = 0.002)和重度ASA组(p < 0.001)相比，DAPT组需要更高的PLT量。与对照组(p = 0.002)、轻度ASA组(p = 0.009)和重度ASA组(p = 0.016)相比，DAPT组的冷沉淀量更高。结论。有DAPT残留效应的患者以及ASA残留效应明显的患者术后出血和胸部再探查的风险更高，输血需求增加。

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Early clinical outcomes of surgical myocardial revascularization in patients with preoperative platelet dysfunction

Background/Aim. Coronary artery bypass grafting (CABG) is the treatment of choice for significant number of the patients with ischemic heart disease. Some of the postoperative complications are closely linked with the preoperative antiplatelet therapy (APT). The aim of this study was to compare the early clinical outcomes of CABG in patients with preserved platelet (PLT) function and patients with platelet function impaired by the residual therapeutic effect of APT. Methods. A total of 181 patients with isolated CABG were enrolled in this prospective, nonrandomized, observational study. Subjects were divided in four groups: Control (arachidonic acid-dependent PLT aggregation - ASPI) ? 790 AU/min, adenosine diphosphate (ADP) ? 406 AU/min, Mild acetylsalicylic acid - ASA (ASPI 410-789 AU/min), Pronounced ASA (ASPI ? 409 AU/min) and dual APT (DAPT) (ASPI ? 789 AU/min; ADP ? 405 AU/min). Preoperative data, intraoperative characteristics and postoperative outcomes were obtained and compared between groups. Results. A significant difference was found regarding the average time of APT cessation between groups (p < 0.001). DAPT group had significantly higher drainage compared to Control group (p = 0.004), Mild ASA group (p = 0.001) and compared to Pronounced ASA group (p = 0.006). Pronounced ASA group had significantly higher rate of chest reexploration compared to Mild ASA group (p = 0.032). DAPT group required significantly more packed red blood cells (PRBC) compared to Control group (p < 0.001) and Mild ASA group (p = 0.009). Pronounced ASA group received significantly more PRBC compared to Control group (p < 0.001) and Mild ASA group (p = 0.019). DAPT group required higher amounts of PLT compared to Control group (p < 0.001), Mild ASA group (p = 0.002) and Pronounced ASA group (p < 0.001). DAPT group received higher amounts of cryoprecipitate compared to Control group (p = 0.002), Mild ASA group (p = 0.009) and Pronounced ASA group (p = 0.016). Conclusion. Patients with a residual effect of DAPT as well as patients with a pronounced residual effect of ASA have a higher risk of postoperative bleeding and chest reexploration, and increased transfusions demands.

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