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手术前的双重抗血小板治疗增加了紧急冠状动脉旁路手术后的风险:荷兰的心脏注册研究

Heleen J C L Apostel¹, Maaike M Roefs², Amon Heijne³

¹Department of Anesthesia, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands.

|December 31, 2025

概括

在紧急冠状动脉旁路移植之前的双重抗血小板治疗会增加出血和死亡风险. 不一致的做法凸显了需要标准化指导方针来管理经过手术的急性冠状动脉综合征患者.

科学领域:

心脏病学心脏病学
心血管外科心血管外科
临床研究临床研究

背景情况:

双抗血小板治疗 (DAPT) 是标准的后急性冠状动脉综合征 (ACS).
在紧急冠状动脉旁路移植 (CABG) 之前对DAPT的术后管理是有争议的.
对于急需CABG的ACS患者,最佳的抗血小板策略需要澄清.

研究的目的:

评估术前DAPT对手术和术后结果的影响.
评估在 ACS 后接受紧急 CABG 的患者的结果.
分析最近的DAPT与紧急CABG患者的结果之间的关联.

主要方法:

对6913名患者进行回顾性队列研究,在ACS后90天内接受紧急隔离CABG.
患者接受DAPT (阿司匹林+P2Y12抑制剂在手术前48小时内) 与单独服用阿司匹林的比较.
倾向得分匹配和多变量逻辑回归用于混调整.

主要成果:

最近的DAPT使用独立地与外科手术期间出血并发症的增加有关.
较高的再干预率 (OR,1.78),输血 (OR,1.85),和手术死亡率 (OR,2.02) 被观察到与DAPT.
在DAPT使用中存在显著的医院间差异 (12%-84%),表明实践不一致.

结论:

在紧急CABG之前最近的DAPT显著增加了外科手术期间出血风险,输血需求和死亡率.
在各中心使用DAPT的实质性变化需要标准化,基于证据的指南.
优化抗血小板管理对于接受手术重血管化的高风险ACS患者至关重要.

关键词:

急性冠状动脉综合征是什么流血出血流血出血冠状动脉绕道移植冠状动脉绕道移植双重抗血小板疗法双重抗血小板疗法心肌梗塞的心脏病发作全国范围的注册登记.外科手术的结果.

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