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克洛皮多格雷尔前期治疗在非抽动心脏手术中的效果:我们是否会失去减少出血后果的好处?

Emmanouil I Kapetanakis1, Diego A Medlam, Kathleen R Petro

  • 1Department of Surgery, Washington Hospital Center, Washington, DC 20010-2975, USA. emmanouil.kapetanakis@medstar.net

Circulation
|March 29, 2006
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概括

术前的克洛皮多格勒增加了出血风险和输血需求在非抽动冠状动脉旁路移植手术中. 然而,这种药物并没有影响手术结果或死亡率.

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科学领域:

  • 心血管外科心血管外科
  • 药理学 药理学是指药理学的学科.
  • 血液学 血液学 血液学

背景情况:

  • 克洛皮多格雷尔前期治疗减少了穿皮冠状动脉再血管化后的血栓事件.
  • 然而,克洛皮多格雷尔的不可逆转的血小板抑制会增加手术患者的出血风险和输血需求.
  • 与传统方法相比,非抽动冠状动脉旁路移植 (CABG) 手术提供较低的出血后续.

研究的目的:

  • 评估手术前克洛皮多格雷尔对血液静止检查,血液产品输血率,发病率和死亡率的影响.
  • 为了评估在接受非抽CABG手术的患者中这些结果.
  • 采用了大量患者样本和风险调整方法进行可靠的分析.

主要方法:

  • 追溯分析1572名接受了隔离的CABG外抽手术的患者 (2000年1月 - 2002年6月).
  • 患者被分为两组:那些接受了手术前克洛皮多格雷尔 (17.9%) 和那些没有 (82.1%).
  • 用风险调整后勤回归和倾向分数匹配的对分析来评估结果.

主要成果:

  • 接受克洛皮多格雷尔的患者显示出血静再手术的可能性显著更高 (OR,5.1;P<0.01).
  • 克洛皮多格雷尔组中观察到对红细胞 (OR,2.6;P<0.01),多个单位 (OR,1.6;P=0.02) 和血小板输血 (OR,2.5;P<0.01) 的需求增加.
  • 在手术结果或手术后死亡率方面,两组之间没有发现统计学上显著的差异 (1.4%对1.4%;P=1.00).

结论:

  • 手术前使用克洛皮多格雷尔与血液静止性重新手术的风险增加有关.
  • 克洛皮多格雷尔的使用显著增加了在非抽血CABG手术期间和之后对血液产品输血的需求.
  • 尽管增加了出血风险,但克洛皮多格雷尔并没有对这一患者队列的整体手术结果或死亡率产生不利影响.