Neposredni ishodi hirurške revaskularizacije miokarda kod bolesnika sa preoperativnom disfunkcijom trombocita

  • Vladimir Stojiljković University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia
  • Aleksandar Kamenov University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia
  • Milan Lazarević University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
  • Mladjan Golubović University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
  • Velimir Perić University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
  • Marija Stošić University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
  • Saša Živić University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia
  • Dragan Milić University Clinical Center of Niš, Department of Cardiac Surgery, Niš, Serbia; University of Niš, Faculty of Medicine, Niš, Serbia
Ključne reči: aortokoronarno premošćavanje, koronarna bolest, trombociti, agregacija, antiagregaciona sredstva, lečenje, ishod

Sažetak


Uvod/Cilj. Hirurška revaskularizacija miokarda (coronary artery bypass grafting – CABG) kod značajnog broja bolesnika je osnovni vid lečenja ishemijske bolesti srca. Neke od postoperativnih komplikacija su blisko povezane sa preoperativnom antiagregacionom terapijom (AAT). Cilj rada bio je da se uporede neposredni ishodi CABG kod bolesnika sa očuvanom funkcijom trombocita i bolesnika kod kojih je funkcija trombocita bila narušena rezidualnim efektom AAT. Metode. Prospektivnom, opsrevacionom, nerandomizovanom studijom obuhvaćeno je 181 bolesnika sa izolovanim CABG. Bolesnici su bili podeljeni na četiri grupe: kontrolnu grupu (agregacija trombocita zavisna od arahidonske kiseline), sa aspirin-induced platelet inhibition (ASPI) testom ≥ 790 agregacionih jedinica (aggregation units – AU)/min; grupu bolesnika sa blagim efektom (BE) acetilsalicilne kiseline (ASK) (BEASK), sa ASPI testom = 410–789 AU/min; grupu bolesnika sa izraženim efektom (IE) ASK (IEASK), sa ASPI testom ≤ 409 AU/min; grupu bolesnika sa dvojnom (D) AAT (DAAT), sa ASPI testom ≤ 789 AU/min i adenozin difosfat (ADF) testom ≤ 405 AU/min. Preoperativni podaci, intraoperativne karakteristike i postoperativni ishodi upoređeni su među grupama. Rezultati. Ispitivane grupe su se značajno razlikovale u odnosu na prosečno vreme obustave AAT(p < 0,001). DAAT grupa imala je značajno češću drenažu u poređenju sa kontrolnom (p = 0,004), BEASK (p = 0,001) i IEASK (p = 0,006) grupom. Grupa IEASK imala je značajno veću učestalost reeksploracije grudnog koša u poređenju sa BEASK grupom (p = 0,032). Bolesnici iz DAAT grupe primili su značajno više koncentrovanih eritrocita u poređenju sa kontrolnom (p < 0,001) i BEASK (p = 0,009) grupom. Bolesnici iz IEASK grupe primili su značajno više koncentrovanih eritrocita u poređenju sa kontrolnom (p < 0,001) i BEASK (p = 0,019) grupom. DAAT grupa primila je značajno više trombocita u poređenju sa kontrolnom (p < 0,001), BEASK (p = 0,002) i IEASK (p < 0,001) grupom. Transfuzije krioprecipitata bile su značajno češće u DAAT grupi u poređenju sa kontrolnom (p = 0,002), BEASK (p = 0,009) i IEASK (p < 0,016) grupom. Zaključak. Bolesnici sa rezidualnim efektom DAAT, kao i bolesnici sa izraženim rezidualnim efektom ASK imaju povišen rizik od postoperativnog krvarenja i reeksploracije grudnog koša, kao i povećanu potrebu za transfuzijama.

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2023/11/02
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