Effect Of Different Early Postoperative Antithrombotic Therapy On Prognosis Of Patients After OPCAB

ObjectiveTo retrospectively analyze the effects of different early postoperative antithrombotic therapy on patients after off-pump coronary artery bypass grafting(OPCAB)in terms of prognosis of myocardial enzyme changes,postoperative myocardial ischemic events and postoperative hemorrhage.MethodsIn this retrospective analysis study,we evaluated 107 patients who underwent isolate OPCAB in Qilu Hospital from January to July 2018 and divided them into two groups:restarted DAPT early group and restarted DAPT belatedly group.Restarted DAPT early group included 62 patients who restarted DAPT within 72 hours after OPCAB.Restarted DAPT belatedly group included 45 patients with DAPT were restarted after 72h.We compared and analyzed the preoperative clinical data,intraoperative revascularization,postoperative myocardial enzyme changes,postoperative monitoring indicators(ventilator use time,ICU use time,IABP use),the incidence of postoperative complications(bleeding complications,the incidence and mortality of postoperative drainage,perioperative acute myocardial infarction,gastrointestinal bleeding,sternal infection,etc.)and death rates of two groups.Then we divided restarted DAPT early group into two subgroup:triple antiplatelet group and double antiplatelet group.Triple antiplatelet group included 12 cases who used DAPT without tirofiban after OPCAB.And triple antiplatelet group included 50 cases who used DAPT combination with tirofiban.Then we performed the same analysis on these two subgroups.RESULTSThere were no difference between the restarted DAPT early group and the restarted DAPT belatedly group in the baseline data(age,gender,comorbidity,preoperative cardiac function,intraoperative revascularization quality,etc.),postoperative bleeding related indicators,postoperative monitoring indicators and postoperative complications.However,the rate of cTnI decreased in the restarted DAPT early group was faster than that in the restarted DAPT belatedly group(221.40±599.22 vs.27.64±65.46),P<0,05,with statistical difference.And the incidence of cerebrovascular complications after operation was lower(0.0%vs.6.7%,P<0.05).Compared with the "double antiplatelet group",there were more alcoholic patients(75.0%vs.42.0%,P<0.05),more patients with myocardial infarction within 30 days before surgery(25.0%vs.2.0%,P<0.05)and more patients with postoperative low cardiac output(8.3%vs.0.0%,P<0.05)in the "triple antiplatelet group".And the "triple antiplatelet group" patients had lower venous bypass vascular flow(17.11±5.74ml vs.23.10±11.37ml,P<0.05),used more red blood cells(2.83±1.02U vs.1.40±1.51U,P<0.05)and plasma(433.33±233.87ml vs.134.00±235.05ml,P<0.05)during perioperative period,had more postoperative drainage volume in the first day(470.00±162.87ml vs.374.52±131.40ml,P<0.05),decreased more HBG in the first three days(20.45±13.05g/L vs.6.23±13.29g/L,P<0.05),had higher mortality during hospitalization(8.3%vs.0.0%,P<0.05).There were no significant differences in the postoperative cTnI decline rates,other baseline data,intraoperative blood loss,5 days postoperative drainage,ICU time,perioperative IABP use rate,postoperative gastrointestinal bleeding rate and postoperative arrhythmia rate between the two groups(P>0.05).Conclusion1.Early restarted DAPT after OPCAB can promote the recovery of perioperative myocardial injury and reduce the risk of cerebrovascular accident without increasing the risk of postoperative bleeding and other complications.Whether it can improve the long-term patency rate of bridge vessels remains to be followed up.2.For patients with poor condition,the combination of tirofiban on the basis of DAPT within 72 hours after OPCAB may avoid further aggravation of perioperative myocardial injury,although it may lead to the result of increased postoperative bleeding volume,drainage volume,and perioperative blood product requirements.