冠状动脉旁路移植术前替格瑞洛停用时间对围术期出血风险的影响

摘要

目的 探讨冠状动脉旁路移植术(CABG)前停用替格瑞洛的时间对围术期出血风险的影响. 方法 纳入2013年7月至2017年12月行CABG术前服用替格瑞洛的冠心病患者188例,根据术前替格瑞洛停药时间分为≥5 d组(126例)和<5 d组(62例).比较两组基线资料及围术期严重出血资料,单因素和多因素logistic 回归分析严重出血的危险因素.主要终点为围术期严重出血. 结果 31 例(16. 5% )患者出现严重出血,其中≥5 d组有15 例(11. 9% ),<5 d组有16 例(25. 8% ).两组的年龄、性别、术前红细胞压积等基线资料无明显差异(均为 P>0. 05).多因素logistic回归分析显示,急性心肌梗死史(OR =5. 49,95% CI:1. 25 ~24. 17)和替格瑞洛停药 <5 d (OR=2. 50,95% CI:1. 13~5. 56)是严重出血的危险因素. 结论 替格瑞洛术前停药时间小于5 d可增加CABG患者围术期严重出血风险.%Objective To evaluate the effect of hemorrhagic risk of time of discontinuation of ticagrelor before coronary artery bypass grafting ( CABG) on perioperative period. Methods A total of 188 patients on ticagrelor and scheduled for CABG enrolled into this study from July 2013 and December 2017. The patients were divided into the≥5 d (n=126) group and the <5 d group (n=62) according to ticagrelor discontinuation time before CABG operation. Baseline characteristics and hemorrhagic data were compared between two groups. Univariate and multivariate logistic regression analyses were performed to investigate the risk factors of major bleeding. The primary endpoint was major bleeding. Results 31 patients had major bleeding (16. 5% ). Among those patients, 15 cases were in the≥5 d group (11. 9% ) and 16 in the <5 d group (25. 8% ). Baseline characteristics, such as age, male ratio, hematocrit, were similar between the two groups (all P>0. 05). Multivariate logistic regression analysis showed that the acute myocardial infarction (OR =5. 49, 95% CI:1. 25-24. 17) and discontinuation less than 5 d of ticagrelor (OR=2. 50, 95% CI:1. 13-5. 56) were risk factors for major bleeding. Conclusions Discontinuation of ticagrelor less than 5 days before CABG may increase the risk of severe perioperative bleeding in CABG patients.