在抗血小板治疗期间接受心脏手术的患者进行血小板功能测试是否有作用?
Elisabeth Mahla1, Udaya S Tantry2, Florian Prüller3
1Department of Anesthesiology and Intensive Care Medicine (E.M.), Medical University of Graz, Austria.
Circulation
|November 27, 2018
概括
以血小板功能检测为指导,对心脏手术患者的个性化P2Y12抑制剂停用可以优化安全性. 这种方法可以减少冠状动脉旁路移植之前的出血风险和等待时间.
科学领域:
- 心脏病学
- 药理学
- 临床医学
背景情况:
- 在高达11%的急性冠状动脉综合征患者中进行冠状动脉旁路移植 (CABG).
- 目前的指导方针建议在CABG之前使用标准化的P2Y12受体阻断剂,不考虑个体患者的变化.
- 这种适合所有人的方法可能无法充分平衡出血风险和抗血小板治疗的需要.
研究的目的:
- 在心脏手术前审查当前的双抗血小板治疗 (DAPT) 停用方案的合理性和局限性.
- 讨论用于评估P2Y12抑制剂药理动力学的可用的血小板功能测试.
- 研究心脏手术患者的血小板抑制,临床因素和出血风险之间的关系.
主要方法:
- 对P2Y12受体阻断剂,血小板功能测定和心脏手术结果的文献综述.
- 对当前的指导方针及其对DAPT管理的建议进行分析.
- 关于血小板功能监测对临床结果的影响的综合证据.
主要成果:
- 观察性研究表明客观的血小板功能测量可以缩短P2Y12抑制剂的停用期.
- 血小板功能测试可以帮助减轻出血风险,同时减少手术前的等待时间.
- 目前有两份指导方针建议对心脏手术患者进行血小板功能检测.
结论:
- 对于接受心脏手术的特定患者,对血小板功能进行个性化评估可能是有益的.
- 血小板功能监测可能可以完善手术前的DAPT管理策略.
- 进一步的研究可能会澄清将血小板功能测试纳入外科护理的最佳方案.
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