冠状动脉旁路移植术前不停用阿司匹林抗血小板治疗有效性和安全性的Meta分析

Efficacy and Safety of Coronary Artery Bypass Grafting Without Stopping Pre-operative Aspirin Administration: A Meta Analysis

目的:系统评价冠状动脉旁路移植术(CABG)前不停用阿司匹林抗血小板治疗的有效性和安全性。方法:计算机检索The Cochrane Library(2014第2期)、Pub Med、EMbase、CBM、CNKI、Wan Fang Data和VIP,收集有关CABG前停用或不停用抗血小板治疗的随机对照研究,检索时限均为从建库至2014-07。由两位评价者根据纳入、排除标准独立选择文献、提取资料和评价纳入研究的方法学质量后,采用Rev Man 5.2软件进行Meta分析。结果:最终纳入8个随机对照研究,共计1 945例患者,Meta分析结果显示:与CABG前停用阿司匹林组相比,不停用阿司匹林组术后出血引流量[平均差(MD)=235.97,P=0.01]、二次开胸止血发生率[比值比(OR)=2.4,P=0.0005]及新鲜冰冻血浆输入量(MD=0.79,P<0.0001)明显增加;但在浓缩红细胞输入量(MD=0.66,P=0.05)、血小板输入量(MD=0.99,P=0.25)、术后心肌梗死发生率(OR=1.03,P=0.90)及术后死亡率(OR=1.24,P=0.56)方面,两组差异无统计学意义。结论:CABG前不停用阿司匹林会增加术后出血量、新鲜冰冻血浆输入量及二次开胸止血发生率。术前低剂量的阿司匹林可能有待于上述问题的解决。

Objective： To systemically evaluate the efifcacy and safety of coronary artery bypass grafting （CABG） without stopping pre-operative aspirin administration for anti-platelet therapy in relevant patients. Methods： The computer searching including Cochrane Library （Issue 2, 2014）, PubMed, EMbase, CBM, CNKI, WanFang Data and VIP was conducted to collect the randomized controlled trial （RCT） for CABG without stopping pre-operative aspirin administration from the data base establishment until 2014-07. There were 2 reviewers identiifed the literatures independently according to inclusion, exclusion criteria, and extracted the information, evaluated the quality of assessment methods, then meta-analysis was performed by RevMan 5.2 software. Results： A total of 8 RCT studies including 1945 patients were enrolled. The meta analysis showed that compared with stopping pre-operative aspirin administration, the patients without stopping pre-operative aspirin had obviously increased post-operative bleeding drainage as MD=235.97,P=0.01, re-operation for bleeding as OR=2.4,P=0.0005 and fresh frozen plasma transfusion requirement as MD=0.79,P〈0.0001. While the packed red blood cell （PRBC） transfusion requirement as MD=0.66, P=0.05, platelet transfusion requirement as MD=0.99,P=0.25, the incidence rate of post-operative myocardial infarction as OR=1.03,P=0.90 and post-operative mortality （OR=1.24,P=0.56） were similar between two conditions. Conclusion： CABG without stopping pre-operative aspirin administration may increase the post-operative bleeding,transfusion and re-operation for bleeding; low dose aspirin administration before CABG needs further investigation to solve the above problems in clinical practice.