Preoperative Continuation of Aspirin Therapy May Improve Perioperative Saphenous Venous Graft Patency After Off-Pump Coronary Artery Bypass Grafting
Preoperative Continuation of Aspirin Therapy May Improve Perioperative Saphenous Venous Graft Patency After Off-Pump Coronary Artery Bypass Grafting
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DOI：
10.1016/j.athoracsur.2014.07.074
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发表时间：
2015-02-01
影响因子：
4.6
通讯作者：
Zhang, Jing
中科院分区：
文献类型：
--
作者：
Wu, Hengchao;Wang, Jian;Zhang, Jing
背景关于非体外循环冠状动脉旁路移植术（OPCAB）患者术前持续阿司匹林治疗对围手术期移植物通畅性影响的信息有限。我们试图评估术前持续阿司匹林治疗对OPCAB后围手术期移植物通畅的影响。我们回顾性收集了2009年10月至2012年9月在阜外医院由一名外科医生进行首次单独OPCAB的582例连续患者的数据，评价了OPCAB前阿司匹林（每日100 mg）与院内不良术后事件风险之间的关系。主要结局为住院死亡率和移植物通畅率。次要结局指标为与手术相关的结局（再探查率、输血量、围手术期引流量损失）。术后住院期间无死亡病例。术前继续接受阿司匹林治疗的患者（n = 400）的术后隐静脉移植物通畅率显著高于术前未接受阿司匹林治疗的患者[98.2% vs 96.1%，p = 0.02]。多变量分析表明，术前停用阿司匹林治疗显著增加了隐静脉移植物闭塞的风险（比值比，2.193; 95%置信区间，1.023至4.701，p = 0.043）。两组围手术期出血风险无显著差异，包括胸管引流、血制品输注和因出血而再次手术。这项研究表明，术前继续阿司匹林治疗可以改善OPCAB后围手术期大隐静脉移植物的通畅性，而不会增加围手术期出血的风险。(C)2015年美国胸外科医师协会
Background. There is limited information about the effect of preoperative continuation of aspirin therapy on perioperative graft patency in patients undergoing off-pump coronary artery bypass (OPCAB). We sought to evaluate the effect of preoperative continuation of aspirin therapy on perioperative graft patency after OPCAB.Methods. Using retrospectively collected data from 582 consecutive patients undergoing first-time isolated OPCAB by a single surgeon at Fuwai Hospital from October 2009 through September 2012, we evaluated the association between aspirin (100 mg daily) preceding OPCAB and the risk of adverse in-hospital postoperative events. The primary outcomes were in-hospital mortality and graft patency. The secondary outcome measures were hemorrhage-related outcomes (reexploration rate, blood transfusions, perioperative drainage loss).Results. There was no death in the postoperative hospitalization period. Patients receiving preoperative continuation of aspirin therapy (n = 400) had significantly higher postoperative saphenous venous graft patency than did those not receiving preoperative aspirin [98.2% vs 96.1%, p = 0.02]. Multivariate analysis indicated that preoperative discontinuation of aspirin therapy significantly increased the risk of occlusion of saphenous venous graft (odds ratio, 2.193; 95% confidence interval, 1.023 to 4.701, p = 0.043). No significant differences between the two groups were observed in perioperative bleeding risks, including chest tube drainage, blood product transfusion, and reoperation for bleeding.Conclusions. This study indicates that preoperative continuation of aspirin therapy may improve perioperative saphenous vein graft patency after OPCAB without increasing the risk of perioperative bleeding. (C) 2015 by The Society of Thoracic Surgeons