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Abstract:
BACKGROUND:Patients with preoperative dual antiplatelet therapy prior to coronary artery bypass surgery are at risk of bleeding and blood component transfusion. We hypothesise that an optimised cardiopulmonary bypass strategy reduces postoperative blood loss and transfusions. METHODS:In total, 60 patients admitted for coronary artery bypass grafting with ticagrelor and aspirin medication withdrawn <96 hours before surgery were prospectively randomised into two equal sized groups. Cardiopulmonary bypass combined a closed Cortiva® heparin-coated circuit with low systemic heparinisation (activated clotting time < 250 seconds) and intraoperative cell salvage in the study group, whereas the control group used a Balance® coated open circuit, full systemic heparinisation (activated clotting time > 480 seconds) and conventional cardiotomy suction. This perfusion strategy was evaluated by the chest drain volume after 24 hours, perioperative haemoglobin and platelet loss accompanied by global coagulation assessments. RESULTS:Patients in the study group demonstrated significantly better outcomes signified by lower blood loss 554 ± 224 versus 1,100 ± 989 mL (p < 0.001), reduced packed red cell transfusion 7% versus 53% (p < 0.001), reduced haemoglobin -28 ± 15 versus -40 ± 14 g/L (p = 0.004) and platelet loss -35 ± 36 versus -82 ± 67 × 109/L (p = 0.001). Indices of rotational thromboelastometry indicated shorter clotting times within the internal and external pathways. Adenosine diphosphate activated platelet function was within normal range based on Multiplate® aggregometry, while ROTEM® platelet analyses indicated inhibited function both preoperatively and post-bypass. Platelet inhibition by aspirin was verified throughout the perioperative period. Platelet function showed no intergroup differences. CONCLUSION:A stringent perfusion strategy reduced blood loss and transfusions in dual antiplatelet therapy patients requiring urgent surgery.
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最新影响因子:1.581 | 期刊ISSN:0267-6591 | CiteScore: |
出版周期:Bimonthly | 是否OA:YES | 出版年份:1986 |
期刊官方网址:http://prf.sagepub.com/
期刊投稿地址:http://www.sagepub.com/journals/Journal201824/manuscriptSubmission
自引率:13.30% | 研究方向:医学-外周血管病 |
出版地区:ENGLAND |
SCI期刊coverage:Science Citation Index Expanded(科学引文索引扩展)
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Published by Sage Publications. ISSN (printed): 0267-6591. ISSN (electronic): 1477-111X. Perfusion provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use
由Sage出版社出版。ISSN(印刷):0267 - 6591。ISSN(电子):1477 - 111 x。 灌注提供灌注、氧合、生物相容性及其应用的最新信息
大类(学科) | 小类(学科) | 学科排名 |
医学 |
CARDIAC & CARDIOVASCULAR SYSTEMS (心脏和心血管系统) 4区 PERIPHERAL VASCULAR DISEASE (外周血管病) 4区 |
112/128 62/65 |
年度总发文量 | 年度论文发表量 | 年度综述发表量 |
100 | 95 | 5 |
引文计数(2018)
文献(2015-2017)
次引用
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