Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting
Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting
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DOI：
10.1016/j.jtcvs.2004.02.019
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发表时间：
2004-09-01
影响因子：
6
通讯作者：
Nussmeier, NA
中科院分区：
文献类型：
--
作者：
Chen, LQ;Bracey, AW;Nussmeier, NA
目的：为了尽量减少输血的患者接受择期冠状动脉旁路移植术后，最近氯吡格雷曝光，我们研究了实验室检查预测血小板功能障碍，并使用了严格的算法驱动的治疗bleeding.Methods：45例患者接受氯吡格雷6天内的操作和45个对照组进行了研究。在肝素化前、鱼精蛋白给药后以及之后每2小时测量凝血酶原时间、活化部分凝血活酶时间、血小板计数和血小板功能检测结果。没有输血管理，除非病人符合实验室和临床critics.Results：血液动力学驱动的治疗出血显着减少了约三分之一的所有血液成分的平均单位输血，如所示，通过比较与当前的控制和历史数据。与目前的对照受试者相比，氯吡格雷接受者需要显著更多的血小板输注（9.0 +/- 1.7 vs 1.2 +/- 0.5 U; P < .0001）和红细胞压积（4.3 +/- 0.6 vs 2.3 +/- 0.5 U; P = .01），需要更长时间的受控通气（12.4 +/- 1.3 vs 8.6 +/- 0.8小时; P = .02）。应用二磷酸腺苷聚集测定法测定体外循环肝素给药前血小板功能障碍（反应< 40%），预测除1例需要多次输血的严重凝血病外的所有病例（16.6 +/- 2.8 U血小板和5.8 +/- 1.0 U浓缩红细胞）。结论：严格的输血算法可以减少所有血液成分的输血要求。使用二磷酸腺苷聚集测定法对血小板功能进行肝素前检测可以识别围手术期出血和输血风险最高的患者，并可能进一步降低围手术期输血需求。
Objective: In an effort to minimize transfusions in patients undergoing elective coronary artery bypass grafting operations after recent clopidogrel exposure, we studied laboratory tests predictive of platelet dysfunction and used a strict algorithm driven treatment of bleeding.Methods: Forty-five patients receiving clopidogrel within 6 days of the operation and 45 control subjects were studied. Prothrombin time, activated partial thromboplastin time, platelet count, and platelet function test results were measured before heparinization, after protamine administration, and then every 2 hours. No transfusions were administered unless a patient met both laboratory and clinical criteria.Results: Algorithm-driven treatment of bleeding significantly reduced the mean units of all blood components transfused by about one third, as shown by comparison with current control and historical data. Compared with current control subjects, clopidogrel recipients required significantly more transfusions of platelets (9.0 +/- 1.7 vs 1.2 +/- 0.5 U; P < .0001) and packed red blood cells (4.3 +/- 0.6 vs 2.3 +/- 0.5 U; P = .01) and required longer periods of controlled ventilation (12.4 +/- 1.3 vs 8.6 +/- 0.8 hours; P = .02). Preoperative platelet dysfunction before heparin administration for cardiopulmonary bypass, as measured by using adenosine diphosphate aggregometry (response < 40%), predicted all but 1 case of severe coagulopathy requiring multiple transfusions (16.6 +/- 2.8 U of platelets and 5.8 +/- 1.0 U of packed red blood cells).Conclusions: A strict transfusion algorithm can reduce the transfusion requirement for all blood components. Preheparin testing of platelet function with adenosine diphosphate aggregometry can identify patients at highest risk for perioperative bleeding and transfusions and might further reduce the perioperative transfusion requirement.