Zeitschrift für Kardiologie

, Volume 93, Issue 9, pp 679–685 | Cite as

ZURÜCKGEZOGEN: Dringliche oder notfallmäßige Koronarrevaskularisation unter Verwendung beider Arteria Thoracica interna nach vorheriger Thrombozytenaggregationshemmung mit Clopidogrel

  • F. Schmidtler
  • B. Gansera
  • K. Spiliopoulos
  • I. Angelis
  • P. Neumaier-Prauser
  • B. M. Kemkes
ORIGINALARBEIT

Zusammenfassung.

Hintergrund:

Die Verabreichung von Clopidogrel vor diagnostischen oder therapeutischen perkutanen Koronarinterventionen zur Prävention einer Stentthrombose gilt mittlerweile als Standardtherapie. Die irreversible Gerinnungshemmung verursacht vermehrte Blutungskomplikationen, wenn eine dringliche ACB-Operation notwendig wird. Die folgende Studie untersucht die Blutungskomplikationen nach vorangegangener Clopidogreltherapie bei dringlicher ACBOperation unter gleichzeitiger Verwendung beider A. Thoracica interna (ITA) sowie Vena-Saphena-magna-Transplantaten bei allen Patienten.

Methodik:

Wir analysierten retrospektiv 166 Patienten (operiert zwischen 1/00 und 12/02) die sich einer dringlichen oder notfallmäßigen ACB-Operation unter Verwendung beider ITAs unterzogen. Hierbei verglichen wir 83 Patienten, die innerhalb der letzen 5 Tage vor OP Clopidogrel und Aspirin erhalten hatten mit 83 Patienten ohne Clopidogrel-Therapie. Ausgewertet wurde Drainagenblutförderung, Re-Thorakotomierate, Notwendigkeit der Übertragung von Blutprodukten, Beatmungsdauer und Intensivaufenthalt.

Resultate:

Beide Gruppen waren vergleichbar hinsichtlich Alter, Geschlecht und Anastomosenanzahl (durchschnittlich 4/Patient). In der Clopidogrelgruppe war die Drainagenförderungsmenge (24 h) mit 935 ± 599 ml vs. 754 ± 335 ml (p = 0,018) und die Re-Thorakotomierate mit 7,2% (6 von 83) vs. 0% (0 von 83) (p < 0,0001) sig. erhöht. In der Clopidogrelgruppe wurden durchschnittlich 2,41 ± 1,88 vs. 1,84 ± 1,47 (p = 0,03) Erythrozytenkonzentrate, 0,43 ± 0,88 vs. 0,024 ± 0,22 (p = 0,0001) Thrombozytenkonzentrate und 0,41 ± 1,14 vs. 0,096 ± 0,59 (p = 0,029) Fresh-Frozen-Plasma-Einheiten übertragen. Die postoperative Beatmungsdauer betrug 11,35 ± 8,77 h vs. 10,57 ± 9,12 h (p = 0,51), der Intensivaufenthalt 32,1 ± 21,8 h vs. 29,8±21,1 h (p=0,48).

Schlussfolgerung:

Die Applikation von Clopidogrel und Aspirin vor dringlicher ACB-Operation führt zu einer vermehrten Drainagenförderung, erhöhten Re-Thorakotomierate und einem höheren Blutproduktbedarf, besonders an Thrombozytenkonzentraten. Nichtsdestotrotz kann bei Patienten mit vorheriger Clopidogreltherapie eine operative Myokardrevaskularisation unter Verwendung beider ITAs mit akzeptablen Blutungskomplikationen durchgeführt werden.

Schlüsselwörter

Clopidogrel ACB 

RETRACTED ARTICLE: Urgent or emergent coronary revascularization using bilateral internal thoracic artery after previous clopidogrel antiplatelet therapy

Summary.

Background:

Application of clopidogrel before diagnostic or therapeutical percutaneous coronary interventions has become standard for stent-thrombosis prevention. The irreversible platelet inhibition causes increasing bleeding complications if urgent coronary artery bypass grafting becomes necessary. This study evaluates the effect on bleeding complications of clopidogrel in urgent CABG using bilateral internal thoracic artery (ITA) and saphenous veins in all patients.

Methods:

We retrospectively analyzed 166 patients (operated between 1/00–12/02) with urgent or emergency CABG, using both ITAs and compared 83 patients with previous (within 5 days) clopidogrel and aspirin application to 83 patients without clopidogrel. We evaluated chest tube output, reexploration rate and necessity of blood products, ventilation time and ICU stay.

Results:

Both groups were comparable with age, gender, number of performed anastomoses (mean 4/ patient). Chest tube output (24 h) was higher in the clopidogrel group (935 ± 599 ml vs 754 ± 335 ml (p = 0.018)), as well as reexploration rate with 7.2% (6 of 83) vs 0% (0 of 83) (p < 0.001). Number of blood products in the clopidogrel group for red cells was 2.41 ± 1.88 U vs 1.84 ± 1.47 U p = 0.03, for plateletes 0.43 ± 0.88 U vs 0.024 ± 0.22 p = 0.0001, for fresh frozen plasma 0.41 ± 1.14 U vs 0.096 ± 0.59 U p = 0.029. Mechanical ventilation time was 11.35 ± 8.77 h vs 10.57 ± 9.12 h p = 0.51, ICU stay 32.1 ± 21.8 h vs. 29.8 ± 21.1 h (p = 0.48).

Conclusions:

Previous application of clopidogrel in combination with aspirin before urgent CABG induces increased chest tube output, reexploration rate and necessity of blood products, especially of plateletes. Nevertheless, routine use of both ITAs in patients after clopidogrel exposure can be performed with acceptable bleeding complications.

Key words

Clopidogrel CABG 

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Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • F. Schmidtler
    • 1
  • B. Gansera
    • 1
  • K. Spiliopoulos
    • 1
  • I. Angelis
    • 1
  • P. Neumaier-Prauser
    • 1
  • B. M. Kemkes
    • 1
  1. 1.Krankenhaus München-Bogenhausen, Abt. für KardiovaskularchirurgieMünchenGermany

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