术前双重抗血小板对急性A型主动脉夹层术后早期的影响

The impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection patients undergoing aortic surgery

目的评估术前双重抗血小板治疗对急性A型主动脉夹层术后住院结局的影响。方法2015年12月至2017年11月,连续入选的45例术前口服阿司匹林+波立维抗血小板治疗的急性A型主动脉夹层患者在我院行外科手术。其中37例(83%,双抗组)用倾向性评分匹配方法与术前未行抗血小板治疗的74例(对照组)急性A型主动脉夹层患者进行1∶2匹配。对两组出血相关事件(死亡、二次开胸止血、术后12 h引流量≥2000 ml及使用七因子)及输血进行比较。结果出血相关事件在对照组与双抗组发生分别为14例(18.9%)与9例(24.3%),P=0.51。两组术后12 h引流分别为490 ml和500 ml,P=0.85。两组在悬浮红细胞、血浆及血小板输血需求方面均无显著差异。多因素回归分析提示术前双抗为出血相关事件无统计学差异的危险因素(OR=2.97,95%CI:0.87~10.21,P=0.08)。结论术前双重抗血小板不显著增加出血相关事件的发生,术前双抗并非急性A型主动脉夹层急诊手术的禁忌证。

Objective To evaluate the impact of preoperative dual antiplatelet therapy on early outcome of acute type A aortic dissection(ATAAD)patients undergoing aortic surgery.Methods From December 2015 to November 2017,45 consecutive patients with ingestion of aspirin and clopidogrel underwent aortic repair surgery at our center.37 out of 45 patients(83%)were propensity-matched with 74 control ATAAD patients without antiplatelet therapy undergoing aortic surgery in 1∶2 fashion.Thereby,bleeding-related outcome(death,reoperation for bleeding,postoperative blood loss within 12 h≥2000 ml and usage of rFⅦa)and blood transfusion requirement were compared.Results Bleeding-related outcome occurred in 14(18.9%)and 9(24.3%)patients in control and antiplatelet group respectively(P=0.51).Postoperative blood loss within 12 hours was 490 ml in control group,compared to 500 ml in the antiplatelet group(P=0.85).There were no significant differences among the two groups in transfusion requirements of red blood cells,platelets and fresh frozen plasma.Multivariate regression analysis identified antiplatelet therapy as an nonsignifcant risk factor for bleeding-related outcome(OR=2.97,95%CI:0.87-10.21,P=0.08).Conclusion Preoperative dual antiplatelet therapy was not associated with increased risk of bleeding-related outcome and transfusion requirement,and was not a contraindication of emergent surgery for ATAAD patients.