Effects of Preoperative Combined Antiplatelet Agents on the Postoperative Bleeding that Occurs during Off-pump Coronary Artery Bypass Surgery

무심폐기하 관상동맥우회수술에서 아스피린과 Clopidogrel의 수술 전 병합투여가 수술 후 출혈에 미치는 영향

  • Choi, Kang-Joo (Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Seong, Hoo-Sik (Department of Thoracic and Cardiovascular Surgery, Sunlin Hospital, Han-Dong University) ;
  • Kae, Yoe-Kon (Department of Thoracic and Cardiovascular Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 최강주 (고신대학교 의과대학 복음병원 흉부외과학교실) ;
  • 성후식 (한동대학교 선린병원 흉부외과) ;
  • 계여곤 (고신대학교 의과대학 복음병원 흉부외과학교실)
  • Published : 2008.10.05

Abstract

Background: It is well known that preoperative administration of combined antiplatelet agents can have an impact on the postoperative bleeding, the requirement for transfusion and the need for reexploration during on-pump coronary artery bypass surgery. Yet its effects have not been well evaluated in the case of off-pump coronary artery bypass surgery. Material and Method: We performed a retrospective study of nineteen patients who underwent OPCAB from March 2003 to December 2004. All the patients had taken antiplatelet agents until 12 hours before operation. The patients were divided into bo groups as an aspirin group and a combined (aspirin+clopidogrel) group. The perioperative platelet count, the hemoglobin level, the hematocrit, the prothrombin time and the aPTT were compared between both groups. The amount of postoperative bleeding, the transfusion requirement and the need for re-exploration to control bleeding were also compared between both groups. Result: There was no difference of operation time and the intraoperative ACT between the aspirin group and the combined group. The amount of blood loss through the chest tube for 24 hours was not different between the aspirin group $(697{\pm}271mL)$ and the combined group $(944{\pm}432mL)$. The number of patients who received blood transfusion was also not different between both groups. There was no patient who required reexploration for bleeding control in both groups. The perioperative hemoglobin level and hematocrit were also not different between both groups, but the postoperative hemoglobin level and hematocrit were decreased significantly in the group. Conclusion: The Preoperative combined antiplatelet (aspirin+clopidogrel) therapy group was not different from the aspirin group for the amount of postoperative bleeding, the amount of blood transfusion and the need for reexploration during off-pump coronary artery bypass grafting. This subject needs further evaluation because of small population in our study.

배경: 심폐기하 관상동맥우회술시 수술직전 항혈소판제의 병파투여는 수술 후 출혈과 출혈로 인한 수술 등의 합병증에 영향을 주는 것으로 알려져 있다. 하지만 무심폐기 하에서의 관상동맥우회술시 항혈소판제의 병합투여가 수술결과에 미치는 영향에 대해서는 잘 알려져 있지 않아 조사하고자 한다. 대상 및 방법: 2003년부터 2005년까지 무심폐기 하에서 시행한 관상동맥우회수술 중 항혈소판제(아스피린, clopidogrel)를 수술 12시간 전까지 지속적으로 사용한 19예를 대상으로 후향적 조사를 하였다. 수술 전 사용한 항혈소판제의 투여방법에 따라 아스피린 단독투여군 10예와 아스피린+clopidogrel 병합투여군 9예로 나누었는데 수술 전후의 혈소판, hemoglobin, hematocrit, prothrombin 시간, aPTT 그리고 수술 후 출혈과 출혈로 인한 수혈요구와 재수술여부에 대해 두 군을 비교하였다. 결과: 두 군간에 수술시간, 수술 중 2회 이상 측정한 ACT는 차이가 없었다. 수술 후 24시간 흉관을 통한 출혈량은 단독투여군 $697{\pm}271mL$, 병합투여군 $944{\pm}432mL$로 두 군간에 차이가 없었다. 수혈을 받은 환자의 수도 두 군 모두 3명으로 차이가 없었으며 출혈로 인해 재수술을 받은 경우는 두 군 모두 없었다. 수술 전후 측정한 헤모글로빈과 Hematocrit의 수치는 두 군간에는 차이가 없었으나 두 군 모두 수술 후의 수치가 수술 전보다 유의하게 감소하였다. 그러나 수술 전후의 감소량에 있어서는 두 군간에 차이가 없었다. 결론: 무심폐기하 관상동맥우회술에 있어 수술 전 aspirin과 clopidogrel의 병합투여는 aspirin 단독투여에 비해 수술 후 출혈로 인한 수혈이나 재수술 등의 수술조기결과에 있어 차이가 없었다. 하지만 저자의 경우는 대상 군의 수가 적어 향후 이에 대한 추가적인 연구가 필요할 것으로 사료된다.

Keywords

References

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