Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery
Clopidogrel Responsiveness Regardless of the Discontinuation Date Predicts Increased Blood Loss and Transfusion Requirement After Off-Pump Coronary Artery Bypass Graft Surgery
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DOI：
10.1016/j.jacc.2010.03.108
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发表时间：
2010-12-07
影响因子：
24
通讯作者：
Shim, Jae-Kwang
中科院分区：
文献类型：
--
作者：
Kwak, Young-Lan;Kim, Jong-Chan;Shim, Jae-Kwang
目的探讨非体外循环冠状动脉旁路移植术(OPCABG)术后患者接受氯吡格雷治疗后的血小板抑制反应百分率与术后出血和输血需求的关系。主要目的是比较术后出血和输血需求与氯吡格雷的血小板抑制反应百分率之间的关系。结果三个三尖瓣的出血量分别为914+/-264ml、623+/-249ml和683+/-254ml(p=0.001)。三分之一的患者输血明显更多，输血单位也更多。在多变量分析中，第三个三分位数与输血风险增加11倍相关(95%可信区间：2.77%至47.30%，p=0.001)。受试者-操作者特征曲线分析确定的最佳输血临界值为70%的血小板对氯吡格雷的抑制反应(曲线下面积：0.771；95%可信区间：0.674~0.868；P<；0.001)。结论无论接触氯吡格雷的距离有多近，对氯吡格雷的血小板抑制反应率都很高，预示着术后失血量和输血需求的增加，临界值为70%，可增加输血风险。这些发现可能暗示改良的血栓弹性成像在决定需要继续氯吡格雷治疗的患者的OPCABG时机上的潜在作用。(J Am Coll心脏ol 2010；56：1994-2002)(C)2010，美国心脏病学会基金会
Objectives The purpose of this study was to evaluate the association of the percentage of platelet inhibitory response to clopidogrel as assessed by modified thromboelastography with bleeding and transfusion requirement after off-pump coronary artery bypass graft (OPCABG) surgery.Background Interindividual variability of clopidogrel responsiveness may influence bleeding and transfusion requirement.Methods One hundred patients who received clopidogrel within 5 days of OPCABG were prospectively enrolled. The primary end point was to compare post-operative bleeding and transfusion requirement in relation to the tertile distribution of the percentage of platelet inhibitory response to clopidogrel.Results Blood loss in the patients in the third tertile was 914 +/- 264 ml compared with 623 +/- 249 ml in those in the first and 683 +/- 254 ml in those in the second tertiles (p = 0.001). Significantly more patients in the third tertile were transfused, and the number of units transfused was also larger. On multivariate analysis, the third tertile was associated with an 11-fold increased risk of transfusion (95% confidence interval: 2.77 to 47.30, p = 0.001). The optimal cutoff value for the transfusion requirement measured by receiver-operator characteristic curve analysis was 70% platelet inhibitory response to clopidogrel (area under the curve: 0.771; 95% confidence interval: 0.674 to 0.868; p < 0.001).Conclusions A high percentage of platelet inhibitory response to clopidogrel, regardless of the proximity of clopidogrel exposure, predicts increased blood loss and transfusion requirement after OPCABG with a cutoff value of 70% for increased risk of transfusion. These findings might implicate a potential role of modified thromboelastography in deciding the timing of OPCABG in patients who need continued clopidogrel therapy. (J Am Coll Cardiol 2010; 56: 1994-2002) (C) 2010 by the American College of Cardiology Foundation