氯吡格雷治疗患者急诊冠状动脉旁路移植术中血液吸附的随机初步试验。
完整摘要 · 中文译文
背景：接受氯吡格雷治疗的患者在推荐的5天洗脱期之前紧急行冠状动脉旁路移植术（CABG）时，围手术期出血风险增加。本研究评估了术中血液吸附是否能减少此类患者的出血。 方法：在停用氯吡格雷后24小时内接受CABG的患者按1：1随机分配至术中血液吸附组（第1组）或对照组（第2组）。在干预组中，该装置被整合到体外循环（CPB）回路中。疗效通过24小时胸腔引流（CTD）、血液制品输注和因止血需要再次手术干预进行评估。 结果：共50例患者被随机分配（平均年龄64±8.6岁，82%为男性）。两组间基线特征无差异。与第2组相比，第1组中位24小时CTD显著减少，为300mL [250-400] vs. 500mL [400-700]，p = 0.0003；浓缩红细胞输注量0 [0-1] vs. 1 [0-2]单位，p = 0.047；新鲜冰冻血浆0 [0-0] vs. 2 [2-3]单位，p < 0.0001；血小板0 [0-0] vs. 2 [1-3]单位，p < 0.0001。第2组中有1例（4.0%）因止血需要再次手术干预。未观察到与装置相关的严重不良事件。 结论：在这组停用氯吡格雷后24小时内接受CABG的患者队列中，术中血液吸附与术后出血减少及输血需求降低相关。
完整摘要 · 英文原文
BACKGROUND: Patients receiving clopidogrel who undergo urgent CABG before the recommended 5-day washout period are at increased risk of perioperative bleeding. This study evaluated whether intraoperative hemoadsorption can reduce bleeding in such patients. METHODS: Patients undergoing CABG within 24 h of clopidogrel discontinuation were randomized 1:1 to intraoperative hemoadsorption (Group 1) or control (Group 2). In the intervention group, the device was incorporated into the cardiopulmonary bypass (CPB) circuit. Efficacy was assessed by 24-hour chest tube drainage (CTD), blood product transfusions and surgical revisions for bleeding control. RESULTS: A total of 50 patients were randomized (mean age 64 ± 8.6 years, 82% male). There were no differences in baseline characteristics between groups. Group 1 showed significantly reduced median 24-hr CTD of 300mL [250-400] vs. 500mL [400-700], p = 0.0003, transfusions of packed red blood cells 0 [0-1] vs. 1 [0-2] units, p = 0.047), fresh frozen plasma 0 [0-0] vs. 2 [2-3] units, p < 0.0001) and platelets 0 [0-0] vs. 2 [1-3] units, p < 0.0001 compared with Group 2. One revision for bleeding control occurred in Group 2 (4.0%). No device-related serious adverse events were observed. CONCLUSION: In this cohort of clopidogrel-treated patients undergoing CABG within 24 h of discontinuation, intraoperative hemoadsorption was associated with lower postoperative bleeding and transfusion requirements.