双联抗血小板治疗对冠状动脉旁路移植术后出血及输血的影响

Impact of Dual Antiplatelet Therapy on Postoperative Bleeding and Blood Transfusion in Coronary Artery Bypass Grafting

目的评价术后早期应用阿司匹林加氯吡格雷双联抗血小板治疗对冠状动脉旁路移植术(CABG)术后出血及输血的影响。方法将2007年12月至2008年12月期间在我院成功接受CABG的249例患者,随机分配到阿司匹林组(A组)和阿司匹林加氯吡格雷组(AC组),A组125例(口服阿司匹林100mg/d),AC组124例(口服阿司匹林100mg/d+氯吡格雷75mg/d);入选患者在术后48h内开始抗血小板治疗。比较两组患者术前临床基线资料,术中、术后情况;记录两组患者术后胸腔引流量、血液及血液制品使用量。通过线性回归模型进行多因素分析,确定影响术后胸腔引流量增加的相关危险因素。结果两组患者术前、术中的临床基线资料比较差异无统计学意义(P>0.05);A组和AC组给予抗血小板药物后的胸腔引流量比较差异无统计学意义(495.00±270.89mlvs.489.25±316.68ml,t=0.146,P=0.884);A组和AC组输血例数(81例vs.91例,χ2=1.937,P=0.164)、红细胞用量(2.51±2.88Uvs.2.25±2.87U,t=0.690,P=0.491)及血浆用量(195.45±300.88mlvs.223.01±238.68ml,t=0.759,P=0.449)比较差异无统计学意义。两组患者中均未发生围术期死亡、二次开胸止血或严重的胸外出血情况。多元线性回归分析显示:术后早期应用双联抗血小板治疗与术后胸腔引流量之间无显著相关性(r=2.297,95%CI:-64.526,69.121,P=0.946)。结论遵循事先确定的给药方案,在CABG术后早期应用阿司匹林加氯吡格雷不会导致术后出血的增加。

Objective To assess the impact of dual antiplatelet therapy using aspirin and clopidogrel on postoperative bleeding and blood transfusion early after coronary artery bypass grafting （CABG）. Methods In this randomized controlled trial, 249 patients were randomly assigned to 2 groups after coronary artery bypass grafting from December 2007 to December 2008. Daily clopidogrel （75 mg） and aspirin （100 mg） were initiated in 124 patients （group AC） while aspirin （100 mg） alone was administered to 125 patients （group A）. Antiplatelet therapy was initiated within 48h postoperatively. Demographic, operative, and postoperative data were compared between the two groups. Chest tube drainage and quantity of blood products used in both groups were recorded. The effects of the antiplatelet regimen on chest tube drainage were compared using a linear regression model. Results No statistical difference of demographic, operative, and preoperative data was observed between the two groups （P〉0.05）. Chest tube drainage after patients received antiplatelet agents was not significantly different between group A and group AC（495.00±270.89 ml vs. 489.25±316.68ml,t=0.146, P=0.884）. No statistical difference of cases of transfusion（81 cases vs. 91 cases,χ2=1.937, P=0.164） or quantity of red cells （2.51±2.88 U vs. 2.25±2.87 U, t=0.690, P=0.491） and plasma （195.45±300.88 ml vs. 223.01±238.68 ml,t=0.759, P=0.449） transfused was found between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. Early postoperative use of dual antiplatelet therapy was not associated with increased bleeding after coronary artery bypass grafting on multivariable analysis（r=2.297,95%CI：-64.526,69.121,P=0.946）. Conclusion Thepresent study suggests that according to a predefined administration protocol, dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early postoperative period in CABG patients, without increasing the risk of bleeding complications.