冠状动脉旁路移植术前阿司匹林和氯吡格雷不同时间点停药的比较研究

Impact of different timings of preoperative Aspirin combined Clopidogrel discontinuation on clinic outcomes in coronary artery disease patients undergoing CABG surgery

目的探索冠状动脉旁路移植术(coronary artery bypass graft,CABG)前不同时间点停用阿司匹林和氯吡格雷对临床预后的影响.方法选取2017年6月至2018年9月于东南大学医学院附属江阴医院心胸外科以及南京医科大学附属第一医院心胸外科99例经冠状动脉造影(coronary angiography,CAG)提示需行CABG的冠心病(coronary artery disease,CAD)患者,随机分为两组,A组(52例)术前5天起停用阿司匹林和氯吡格雷抗血小板药物,B组(47例)术前7天起停用前述抗血小板药物,比较两组术中及术后临床疗效的差异.结果两组患者术前性别、年龄、体重指数、吸烟史、饮酒史、高血压、糖尿病、高脂血症、合并症、血红蛋白、左心室射血分数(LVEF)和用药史比较均未见统计学差异(P>0.05).术中A组的总出血量多于B组,差异具有统计学意义[(1266±201)ml比(781±189)ml,P=0.02];A组平均红细胞输注量大于B组,差异具有统计学意义[(1479±302)ml比(810±214)ml,P<0.01];A组平均血浆输注量大于B组[(588±191)ml比(307±53)ml,P=0.04];A组平均血小板输注量大于B组[(229±70)ml比(97±41)mi,P<0.005].两组患者在插管时间(44.4 h比17.5 h,P<0.01)、再次手术率(10.7%比2.7%,P<0.01)和术后l周及4周病死率(4.59%比1.76%,P<0.005;5.50%比3.4%,P=0.04)方面相比差异均有统计学意义.结论 CABG术前7天停用抗血小板药物较为合适.

Objective To evaluate the clinic differences in two timings of discontinuation in dual antiplatelet therapy by Aspirin combined Clopidogrel prior to the coronary artery bypass graft (CABG) surgery in coronary artery disease patients. Methods Ninty-nine patients with coronary artery disease (CAD) who scheduled for CABG surgery were enrolled according to the coronary angiography (CAG) results from the Department of Thoracic Surgery, Affiliated Jiangyin Hospital, Southeast University Medical College and First Affiliated Hospital, Nanjing Medical University. The subjects were randomized to two groups: group A: Aspirin plus Clopidogrel withdrawl 5 days prior to CABG( 52 patients);group B: Aspirin plus Clopidogrel withdrawl 7 days prior to CABG (47 patients).The general characteristics and clinic outcomes of the two groups were recorded. Results No significant differences were found between the two groups in preoperational status (such as age, gender, weight index, body mass index, hemoglobin, smoking and drinking history. history of hypertension, diabetes mellitus, hyperlipemia, cardiovascular comorbidity, ejection fraction and medication history). There was statistically significant in total bleeding volume between group A and group B[(1266±201 )ml vs.(781±189) ml, P=0.02]. Compared with grup B. patients of group A required more transfusions of red blood cells [( 1479± 302)ml vs.(810±214)ml,P<0.01], plasma [(588±191 )ml vs.(307±53)ml,P=0.04] and platelet [(229±70)ml vs.(97±41) ml, P<0.005 ]. There were statistical differences in intubation time (44.4 h vs. 17.5 h, P<0.01 ) and reoperation rate ( 10.7% vs. 2.7%, P<0.01) between group A and group B. There were statistical differences in 1 -week postoperative mortality(4.59% vs. 1.76%,/J<0.005 ) and 4-week postoperative mortality(5.5% vs. 3.4%, P=0.04) between group A and group B. Conclusion administration of Aspirin and Clopidogrel until 7 days before receiving CABG surgery is properer and safer in the CAD patients.