The Study On Correlation Between Prothrombotic State And Perioperative Adverse Cardiac Events In Coronary Heart Disease Patients

Objective: To evaluate efficacy of antifibrinolytic agents in coronary artery bypassgrafting (CABG)patients with antiplatelet therapy. Methods: We searched PubMed、EMbase, Highwire, CENTREN and its affiliated clinical trial registration datacenter,CBMdisc,and CNKI databases from2000to2010. Randomized controlled trials(RCTs) were indentified about efficacy of antifibrinolytic agents in CABG patients. Studyselection and meta-analysis were conducted which according to the Cochrane Handbookfor systematic reviews. Date were extracted from these trials by2reviewers independentlyand analyzed by RevMan5.0software. Results: Data from11trials(n=725) confirmed theefficacy of antifibrinolytic therapy compared with control group to reduce both blood by306.5ml（MD=-306.5ml,95%CI：-351.52,-261.52; P<0.00001) and blood transfusionrequirements (OR=0.37,95%CI：0.26-0.51,P<0.00001) in CABG patients receivingantiplatelet. Also to reduce the average of blood transfusion（MD=-0.59,95%CI：-0.69,-0.50，P<0.00001) and the need for surgical re-exploration（OR=0.27;95%CI：0.09、0.78,P=0.02). We found to reduce the incidence of thrombotic events（OR=0.49,95%CI：0.25,0.97, P=0.04). Conclusion: The current evidence shows that the rational use ofantifibrinolytic agents are effective for reducing bleeding, blood transfusion, and theprobability of surgical re-exploration in CABG patients receiving antiplatelet,but doesnot increase the incidence of thrombotic events. Objective: To study correlation between level of molecular markers ofprothrombotic state and perioperative adverse cardiac events in cardiac heart diseasepatients underwent noncardiac Surgery; To research the value and significance whichprethrombotic state molecular marker predict adverse cardiac events in elderly cardiacheart disease Patients underwent non-cardiac surgery in the perioperative period; whichis laid the foundation for improving the preoperative cardiovascular risk assessmentsystem. Methods:128enderly patients electived medium/high-risk noncardiac Surgerywere enrolled in the study. At preoperation,post-operation24,48and72hours detect thelevel of thrombus precursor protein (TpP), P-selectin (CD62-P) and D-dimer (D=D)；Monitoring perioperative ECG and troponin I (cTnI)to determine adverse cardiacevents.To analysis the correlation between prothrombotic state and adverse cardiac events.Results:39.1%patients of the subjects that the level of plasma molecular markers ofprothrombotic state is increase,D=D is the highest in it. Increased groups of level ofprothrombotic state molecular markers compared with the normal groups in adversecardiac events: The incidence of adverse cardiac events was significantly high-er in the level of increased group preoperative D=D, CD62-P and TpP,in particul-ar, There was significant statistical difference in D=D and CD62-P Increased group(χ~2=14.085，P<0.001、χ~2=28.286,P<0.001);3patients of TpP increase group and20.8%patients in125cases of normal group had occured adverse cardiac events, P<0.001;Therewas significant statistical difference in three. logistic regression analysis the influence of factors of adverse cardiac events, Showing that prothrombotic state is a independent riskfactors of it(P<0.05).Conclusion: Indicated adverse cardiac events was significantlyincreased in the increased group of prothrombotic state molecular markers. Increased thelevel of molecular markers of prothrombotic state have a certain anticipation value forperioperative adverse cardiac events; Prothrombotic state and the perioperative adversecardiac events has a significant correlation. It is a important precipitating factor forperioperative adverse cardiac events in coronary heart disease underwent non-cardiacsurgery.