Impact of Discontinued Dual Antiplatelet Therapy Time Before Limited Coronary Artery Bypass Grafting on Post-operative Bleeding Events
10.3969/j.issn.1000-3614.2017.12.010
- VernacularTitle:限期冠状动脉旁路移植术前停用双联抗血小板药物时间对术后出血事件的影响
- Author:
jing Yu CHENG
1
;
Wei LIU
;
xin Ying ZHAO
;
mei Dong SHI
;
yang Yu LIU
;
ming Zhi ZHOU
;
li Xiao LIU
;
Sai LV
;
jie Yu ZHOU
Author Information
1. 首都医科大学附属北京安贞医院 心内 12 病房 北京市心肺血管疾病研究所
- Keywords:
Coronary artery bypass grafting;
Platelet aggregation inhibitors;
Hemorrhage
- From:
Chinese Circulation Journal
2017;32(12):1181-1184
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the impact of discontinued dual antiplatelet therapy(DAPT) of aspirin combining clopidogrel within 5 days on peri-operative bleeding in patients with coronary artery bypass grafting (CABG). Methods: A total of 2012 patients with off-pump CABG were retrospectively enrolled in our study including 1506 male and the mean age was at 61.92 years. All patients received regular DAPT previously and discontinued the medication≤5 days due to emergency or prior limited CABG. Based on the days from discontinued DAPT to operation, the patients were divided into 6 groups: 0-day group, n=220, 1-day group, n=240, 2-day group, n=360, 3-day group, n=332, 4-day group, n=428 and 5-day group, n=432. Relationships between risk factors of bleeding and discontinued DAPT time were studied. Results: Bleeding was defined by BARC (bleeding academic research consortium) standard. The incidences of bleeding events in 0-day group, 1-day group, 2-day group, 3-day group, 4-day group and 5-day group showed a decreasing trend as 29.1%, 24.6%,19.4%, 13.0%, 14.5% and 13.0% respectively, P<0.01. Post-operative chest drainage volume≥2L within 24h (P=0.13) and intracranial bleeding (P=0.60) had no obvious tendency changes; occurrence rates of 48h peri-operative transfusion≥5 U whole blood or red blood cells (P<0.01) and re-operation(P<0.01) had a decreasing trend by prolonged time of discontinued medication. The minor endpoint events were similar. Compared to (3-5) days discontinued medication, the patients with (0-2) days discontinued DAPT were with the higher incidences of overall bleeding, re-operation and 5U transfusion, the differences had statistical meaning. Conclusion: The incidence of bleeding presented a decreasing trend by prolonged time of discontinued DAPT before CABG;transfusion and re-operation had the statistical meaning for bleeding. Discontinued medication less than 3 days may increase bleeding events and therefore, in high risk patients, prior CABG discontinued medication should be more than 3 days.
