Povezanost duljine perioda od isključenja klopidogrela do operacije s aktivnosti trombocitnih adenozin-difosfatnih receptora te opsegom krvarenja i potrebe za transfuzijskim liječenjem kod bolesnika koji se podvrgavaju operaciji koronarnog premoštenja

master's thesis

• Title (english): Association between duration of clopidogrel cessation before coronary artery bypass surgery and adenosine di-phosphate platelet receptors activity and bleeding outcomes/transfusion requirements
• Author: Lucija Konosić
• Mentor: Bojan Biočina (mentor)
• Committee member: Višnja Ivančan (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Bojan Biočina (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

CILJEVI: Cilj studije je utvrditi na koji način vrijeme od isključenja klopidogrela do operacije i trombocitna funkcija mjerena impedancijskom agregometrijom utječu na rizik za ekscesivno krvarenje i transfuzijsko liječenje po operaciji koronarnog premoštenja (CABG). ----- METODE: 277 bolesnika izloženih klopidogrelu unutar 7 dana od CABG-a bilo je podijeljeno u 3 grupe prema vremenu isključenja klopidogrela (Grupa 1: ≤3; Grupa 2: 4-5 i Grupa 3: 6-7 dana prije operacije). 24-satna drenaža na torakalne drenove bila je primarni ishod razmatranja dok je transfuzijsko liječenje bilo sekundarni ishod. ----- REZULTATI:
Bolesnici iz grupe 1 imali su višu stopu komplikacija vezanih za krvarenje kao i stopu transfuzijskog liječenja. Impedancijska agregometrija s testovima ASPI (≤ 25 AUC) i ADP (≤ 63 AUC), kao i prijeoperacijski interval nakon isključenja klopidogrela (≤ 3 dana) bili su prediktori opsega krvarenja. ----- ZAKLJUČAK: Skraćenje vremena čekanja od isključenja klopidogrela do operacijskog zahvata je prihvatljivo ukoliko evidentiramo adekvatnu trombocitnu funkciju (ASPI>25 AUC, ADP>63 AUC).

Abstract (english)

OBJECTIVES: The goal of the present study was to determine how do the timing of clopidogrel discontinuation and the platelet function assessed by multiple electrode aggregometry influence bleeding complications and transfusion requirements in patients undergoing coronary artery bypass (CABG). ----- METHODS: A total number of 277 patients exposed to clopidogrel within 7 days of CABG were divided into three groups based on the number of days without clopidogrel before the surgery (Group 1: ≤3; Group 2: 4-5 and Group 3: 6-7 days). 24h chest tube output was considered as study primary outcome, whereas transfusion requirements were considered to be secondary outcomes. ----- RESULTS: Group 1 patients were found to have a significantly higher rate of bleeding complications and transfusion requirements. Multiple electrode aggregometry ASPI (≤ 25 AUC) and ADP (≤ 63 AUC) tests and the clopidogrel free interval (≤ 3 days) were predictive of bleeding amount. ----- CONCLUSION: The shortening of the waiting period after clopidogrel cessation sounds reasonable if coupled with adequate platelet reactivity.

• Keywords: impedancijska agregometrija; krvarenja; transfuzija; koronarno premoštenje; klopidogrel
• Keywords (english): multiple electrode aggregometry; hemorrhage; transfusion; coronary artery bypass grafting; clopidogrel
• Language: croatian
• URN:NBN: urn:nbn:hr:105:434587
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-17 11:18:03