对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉旁路移植术后桥血管通畅情况的影响

目的对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉(冠脉)旁路移植术(CABG)后桥血管通畅情况的影响。方法选择2011年1月至2017年12月于中国医学科学院阜外医院行心脏瓣膜置换同期CABG手术并规律随诊的患者96例,其中男性78例,年龄(43~73)岁,平均年龄(60.8±9.05)岁。所有患者分为两组,抗血小板组为移植生物瓣或行瓣膜成形术的患者,该组患者双联治疗(拜阿司匹林联合华法林)至术后3~6个月,之后单用拜阿司匹林抗血小板治疗;抗凝组为移植机械瓣的患者,该组患者双联治疗至术后3~6个月后单用华法林抗凝治疗,并按照指南要求维持INR水平。通过收集患者冠脉桥血管CT血管成像检查结果评价桥血管通畅情况。结果抗血小板组和抗凝治疗组乳内动脉桥的通畅率分别为80.0%vs.82.5%(P=0.8),大隐静脉桥通畅率分别为77.2%vs.72.1%(P=0.512);随访期间两组出血事件均为牙龈出血,抗血小板组和抗凝治疗组出血事件比率为14%vs.7.5%(P=0.307),两组间比较差异无统计学意义。结论长期抗凝治疗与抗血小板治疗在维持桥血管通畅率方面无显著差异,且在医师指导下接受抗凝治疗的出血风险并未显著高于抗血小板治疗。

Influence of anti-platelet therapy and anticoagulant therapy on graft patency after cardiac valve replacement and homochronous coronary artery bypass grafting: a comparison study

Objective To compare the influence of anti-platelet therapy and anticoagulant therapy on graft patency after cardiac valve replacement and homochronous coronary artery bypass grafting(CABG).Methods The patients undergone cardiac valve replacement and homochronous CABG(n=96,male 78,aged from 43 to 73 and average age=60.8±9.05)were chosen from Fuwai Hospital of Chinese Academy of Medical Sciences from Jan.2011 to Dec.2017.All patients were divided into anti-platelet therapy group and anticoagulant therapy group.The anti-platelet therapy group undergone biological valve replacement or cardiac valvoplasty was given dual antiplatelet therapy(DAPT,Bayaspirin and warfarin)for 3-6 months after the operation,and then Bayaspirin alone.The anticoagulant therapy group undergone mechanical valve replacement was given DAPT for 3-6 months after the operation,and then warfarin alone.The level of international normalized ratio(INR)was maintained according to requirements.The graft patency was reviewed through collecting patients’results of computed tomography(CT)angiography of coronary bridge.Results The patency rate of internal-mammary artery bridge was 80.0% in antiplatelet therapy group and 82.5%in anticoagulant therapy group(P=0.8).The patency rate of great saphenous vein bridge was 77.2% in anti-platelet therapy group and 72.1%in anticoagulant therapy group(P=0.512).During follow-up period,all bleeding events were gingival bleeding,and rate of bleeding events was 14% in anti-platelet therapy group and 7.5%in anticoagulant therapy group(P=0.307).The difference had no statistical significance between 2 groups.Conclusion There is no significant difference in maintaining patency rate of grafts between long-term anticoagulant therapy and anti-platelet therapy.The bleeding risk of anticoagulant therapy is not significantly higher than that of anti-platelet therapy.