The Efeect Of Antiplatelet Drugs' Application Before Off-pump Coronary Artery Bypass On Postoperative Bleeding And Analyzing Ralative Factors

Objective: The antiplatelet drugs are widespred used before coronary artery bypass grafting(CABG),this test aimed to evaluate the effect of antiplatelet drugs' application before off-pump coronary artery bypass(off-pump CABG)on postoperative bleeding,and analyze the factors which effect the postoperative bleeding by thrombelastogram(TEG).Methods: 92 patients were included who accepted off-pump coronary artery bypass grafting in our cardiac surgery from August 2005 to January2006.Divided these patients into three groups based on the therapy of antiplatelet drugs within 5days before operation: A1(Taken aspirin alone,n=30),A2(Taken clopidogrel and aspirin daily,n=30),B(Stoping taking either oral antiplatelet drugs within 5 days before operation).24 h before operation,92 patients must be tested by thrombelastography(TEG)to get the date: the value of R?K?Angle?MA,Within 24 h before operation.At the same time recorded the basic information of the 92 patients,such as: age?gender?weight ? the history of hypertension and hyperlipidemia and diabetes and smoking? rental function? left main coronary artery disease? the EF value of the echocardiography(UCG).During perioperative period,we also need to record the other information,which included the number of bypass grafts?operative time ? second opening stanching ? cerebral stoke ? myocardial infraction(MI)? the highest value of troponin(CYNI)after operation? 24 h blood loss?total blood loss?the time of pull out the drainage tube?mechanical ventilation time?ICU monitoring time? awake time and requirement of blood products.The operations were managemented by the same operative team.The UCG was managemented by the same same doctor in our cardiac surgery.Results:1 the comparison of the three groups of basic information included age?gender? weight? the history of hypertension and hyperlipidemia and diabetes and smoking? rental function? left main coronary artery disease? the EF value of the echocardiography(UCG)were not statistically significant(P>0.05).2 The comparison of the three groups of bypass grafts? operative time?second opening stanching?cerebral stoke?myocardial infraction(MI)? the highest value of troponin(CTNI)after operation were not statistically significant(P>0.05).3 The comparison of the three groups of 24 h blood loss?total blood loss?the time of pull out the drainage tube ? mechanical ventilation time ? ICU monitoring time and the requirement of blood products were significant difference(P < 0.05).Futher analysis,the comparison of group A2 and the other two groups had significant difference in all of above aspects(P<0.143).And the blood loss? time?requirement of blood products of group A2 were more and higher than the other two groups.While,the comparison of group A1 and group B was significantly different in above aspects expect total blood loss and the time of pull out the drainage tube,and group A1 was more and longer than group B.4 About the value of thrombelastogram,There was significant difference among the three groups in the values before operation(P < 0.05).Futher compared the values after operation,the comparison among three groups in K value was not significantly different(P>0.05).Futher comparison between two: the K value of group A2 was higher than the other two groups,while there was no significant difference between group A1 and group B;the Angle value of group B was lower than the other two,which was not significantly different;the MA value of group A2 was lower than the other two,and the comparison of the other two was not significantly different.And compare the date between preoperative and postoperative,we can see that the MA value of the three groups were reduced than preoperation,which was kept in line with research results of blood loss and the requirement of blood products.Conclusions: The continuous application of antiplatelet drugs before off-pump coronary artery bypass graft will increase the blood loss and the requirement of blood products,whose reason was the reduce of blood coagulation factors and platelet after operation which was found by thrombelastography.