Bleeding-associated outcomes with preoperative clopidogrel use in on- and off-pump coronary artery bypass
Bleeding-associated outcomes with preoperative clopidogrel use in on- and off-pump coronary artery bypass
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体外循环和非体外循环冠状动脉搭桥术中术前使用氯吡格雷的出血相关结局
DOI：
10.1007/s11239-012-0694-x
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发表时间：
2012
影响因子：
4
通讯作者：
R. Becker
中科院分区：
文献类型：
--
作者：
J. Berger;P. Herout;Q. Harshaw;S. Steinhubl;C. Frye;R. Becker
急性冠状动脉综合征患者在冠状动脉搭桥手术前使用氯吡格雷会增加手术相关的发病率。我们研究了氯吡格雷预处理对非体外循环冠脉重建术患者的影响。本报告描述了一项回顾性多中心研究的事后分析，分析了术前（5天内）使用氯吡格雷对出血相关结局和手术再干预的影响。使用逻辑回归分析手术类型和氯吡格雷暴露的结果，同时使用非泵手术的倾向评分风险调整。两组患者住院时间（9.3±5.4天比8.9±5.3天，p = 0.35）、大出血（21%比20%，p = 0.74）、再手术（3.7%比4.8%,p = 0.53）差异无统计学意义。在这两个手术队列中，近期使用氯吡格雷与大出血、再手术和输血的发生率较高相关。多变量调整后，氯吡格雷治疗组大出血的比值比（1.76,95%置信区间0.88-3.52;2.37,95%置信区间1.06-5.30）和再手术的比值比（4.52,95%置信区间0.58-36.6;7.05,95%置信区间0.82-60.5）较未使用氯吡格雷组增加。大出血和再手术在接受开泵手术和停泵手术的患者之间没有显著差异。手术前5天内使用氯吡格雷增加了所有CABG患者出血和再手术的风险，无论手术是开泵还是停泵。
Clopidogrel use prior to coronary artery bypass graft surgery in patients presenting with acute coronary syndromes is associated with a greater incidence of procedural related morbidity. We studied the impact of clopidogrel pre-treatment in patients undergoing off-pump versus on-pump coronary revascularization. This report describes a post hoc analysis of 431 on-pump and 165 off-pump cases from a retrospective multicenter study of the impact of preoperative (within 5 days) clopidogrel use on bleeding related outcomes and surgical reintervention. Logistic regression was used to analyze the outcomes with respect to surgery type and clopidogrel exposure while using a propensity score risk adjustment for off-pump surgery. The hospital length of stay (9.3 ± 5.4 days vs. 8.9 ± 5.3 days, p = 0.35), major bleeding (21% vs. 20%, p = 0.74) and reoperation (3.7% vs. 4.8%, p = 0.53) were similar between on-pump and off-pump, respectively. In both surgical cohorts, recent clopidogrel use was associated with a greater incidence of major bleeding, reoperation, and transfusion. After multivariable adjustment, the odds ratio of major bleeding (1.76, 95% confidence interval 0.88–3.52 on-pump; 2.37, 95% confidence interval 1.06–5.30 off-pump) and reoperation (4.52, 95% confidence interval 0.58–36.6 in on-pump; 7.05, 95% confidence interval 0.82–60.5 in off-pump) was increased in clopidogrel-treated patients compared to no clopidogrel. Major bleeding and reoperation did not differ significantly between patients undergoing on- or off-pump surgery. Clopidogrel treatment within 5 days prior to surgery increased the risk of bleeding and reoperation in all CABG patients irrespective of whether surgery was performed on- or off-pump.