Koroner arter bypass greftleme sonrası aspirin direncinin greft tıkanması üzerine etkisi
Loading...
Date
2009
Authors
Arslan, Sinan
Journal Title
Journal ISSN
Volume Title
Publisher
Uludağ Üniversitesi
Abstract
Koroner arter hastalığında (KAH) doğru endikasyonlarla yapılan cerrahi tedavinin yaşam kalitesini düzelttiği, yaşam süresini uzattığı bilinmektedir Septomatik KAH tedavisinde koroner bypass cerrahisi 1958'den bu yana önemli aşamalar kaydetmiştir fakat bypass greftlerinin yıllar içerisinde tıkanması halen sorun oluşturmaktadır. Bypass sonrası sekonder korunmada aspirin en yaygın kullanılan antitrombotik ilaçtır. Aspirin kullanılmasına rağmen tıkayıcı vasküler olayların ortaya çıkması ve laboratuvar araştırmalarında trombosit fonksiyonlarının, aspirine normal cevap verenlere göre yeterince inhibe edilmediğinin gösterilmesi "aspirin direnci" olarak tanımlanmıştır. Çalışmamızda koroner bypass uygulanmış olan hastalarda Multiplate marka impedans agregometri cihazı ile aspirin direnci değerlendirildi.Çalışmamıza daha önce koroner bypass yapılan, en az 10 gün süreyle 100 mg ve daha fazla aspirin kullanan, endikasyon dahilinde koroner anjiyografi yapılmış 50 hasta dahil edildi. Bypass grefti tıkalı olanlar ile açık olanlar, aspirine dirençli olanlar ile duyarlı olanlar ayrı ayrı karşılaştırıldı. Bu hastalardan 22'sinde en az bir bypass damarı tıkalı, 28'inde ise bypass damarları açıktı. Tüm grup aspirine yanıt bakımından değerlendirildiğinde 50 hastanın 11'inde (%22) aspirin direnci saptandı.Gruplar ayrı ayrı olarak ele alındığında bypass damarı tıkalı olanlarda 7 hastada (%32), bypass damarı açık olan 4 hastada (%14) direnç saptanmıştır. Aradaki farkın istatistiksel olarak anlamlı değildi (p=0,141), bununda örneklem büyüklüğünün yetersiz oluşuna bağlı olduğu düşünüldü. Çalışmaya alınan hastalarda 84'ü safen, 46'sı LİMA olmak üzere toplam 130 greft mevcuttu. Aspirin direnci olan grupta 34 greftin 11'i (%32), Aspirin duyarlı olan grupta 96 greftin 18'i (%18,7) tıkalı olup aradaki fark istatistiksel olarak anlamlıydı (p=0,044).Aspirine dirençli olan grupla aspirine duyarlı olan grup karşılaştırıldığında yaş, cinsiyet, sigara içiciliği, hipertansiyon, diyabet, hiperlipidemi, vücut kitle indeksi, kolesterol değerleri, eritrosit ve trombosit sayısı gibi özellikler ve bypass sonrası geçen süre açısından istatistiksel olarak anlamlı farklılık saptanmadı. Ortalama trombosit hacmi (p=0,046) aspirin dirençli grupta anlamlı olacak şekilde yüksek saptandı. Aspirin direnci olanlar kullandıkları aspirin dozu (100 mg ve 300 mg) açısından karşılaştırıldıklarında iki grup arasında istatistiksel açıdan anlamlı bir fark saptanmamıştır (p=0,489).Sonuç olarak aspirin direncinin bypass grefti tıkanmasına neden olabileceği düşünüldü. Koroner bypasslı hastaların takibinde aspirin cevabının yeterliliğinin impedans agregometri cihazı ile kısa sürede değerlendirilip tedavinin bu sonuçlara göre düzenlenebileceği kanaatine varıldı.
It is known that surgical treatment of coronary artery disease in right indications makes the quality of life better and prolongs the survey. There has been an important progression in the surgical treatment of symptomatic coronary artery disease since 1958 but occlusion of coronary grafts in years is still an important problem. Aspirin is the most commonly used anti-thrombotic drug in the secondary prevention after coronary by-pass surgery. Aspirin resistance is defined as occurance of obstructive vascular events although usage of aspirin and demonstration of less inhibition of thrombocyte functions compared with normal responders to inhibitory effect of aspirin in laboratory examinations. In our study, aspirin resistance in patients who has undergone coronary bypass surgery is evaluated with empedance aggregometry machine of multiplate trademark.In our study, 50 patients who has undergone coronary angiographic examination and who has previous history of coronary by-pass surgery together with aspirin treatment of 100 mg or higher of at least ten days are included.Patients with patent or occluded coronary grafts and patients with or without aspirin resistance are compared seperately. Coronary grafts were patent in 28 patients and at least one coronary graft was occluded in 22 patients. In the evaluation of whole group, aspirin resistance has been found in 11 (22%) patients.When the groups are evaluated seperately, aspirin resistance has been found in 7 (32%) patients with occluded coronory grafts and in 4 (14%) patients with patent coronary grafts. The difference was not istatistically important (p=0,141) and inadequate number of sample is considered to be reason of it. There were totally 130 coronary grafts, 84 of them were saphenous and 46 of them were LİMA. 11 (32%) of 34 coronary grafts in aspirin resistance group and 18 (18,7%) of 96 coronary grafts in aspirin sensitive group have been found occluded and the differance between groups was istatistically important (p=0,044).There was no istatically important differance between aspirin sensitive and resistance groups in terms of age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, body mass index, cholesterol levels, number of thrombocyte and erytrocyte, time after coronary by-pass surgery. Mean platelet volume was higher in aspirin resistance group in an istatistically important manner (p=0,046). There were no istatistically important difference between groups when patients in the aspirin resistance group has been devided according to dosage of aspirin (100 mg versus 300 mg) (p=0,489).As a result, it has been thought that aspirin resistance may lead to coronary graft occlusion. In the follow up of patients with coronary by-pass surgery, treatment may be rearrenged in case of aspirin resistance detected with empedance aggregometry device.
It is known that surgical treatment of coronary artery disease in right indications makes the quality of life better and prolongs the survey. There has been an important progression in the surgical treatment of symptomatic coronary artery disease since 1958 but occlusion of coronary grafts in years is still an important problem. Aspirin is the most commonly used anti-thrombotic drug in the secondary prevention after coronary by-pass surgery. Aspirin resistance is defined as occurance of obstructive vascular events although usage of aspirin and demonstration of less inhibition of thrombocyte functions compared with normal responders to inhibitory effect of aspirin in laboratory examinations. In our study, aspirin resistance in patients who has undergone coronary bypass surgery is evaluated with empedance aggregometry machine of multiplate trademark.In our study, 50 patients who has undergone coronary angiographic examination and who has previous history of coronary by-pass surgery together with aspirin treatment of 100 mg or higher of at least ten days are included.Patients with patent or occluded coronary grafts and patients with or without aspirin resistance are compared seperately. Coronary grafts were patent in 28 patients and at least one coronary graft was occluded in 22 patients. In the evaluation of whole group, aspirin resistance has been found in 11 (22%) patients.When the groups are evaluated seperately, aspirin resistance has been found in 7 (32%) patients with occluded coronory grafts and in 4 (14%) patients with patent coronary grafts. The difference was not istatistically important (p=0,141) and inadequate number of sample is considered to be reason of it. There were totally 130 coronary grafts, 84 of them were saphenous and 46 of them were LİMA. 11 (32%) of 34 coronary grafts in aspirin resistance group and 18 (18,7%) of 96 coronary grafts in aspirin sensitive group have been found occluded and the differance between groups was istatistically important (p=0,044).There was no istatically important differance between aspirin sensitive and resistance groups in terms of age, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, body mass index, cholesterol levels, number of thrombocyte and erytrocyte, time after coronary by-pass surgery. Mean platelet volume was higher in aspirin resistance group in an istatistically important manner (p=0,046). There were no istatistically important difference between groups when patients in the aspirin resistance group has been devided according to dosage of aspirin (100 mg versus 300 mg) (p=0,489).As a result, it has been thought that aspirin resistance may lead to coronary graft occlusion. In the follow up of patients with coronary by-pass surgery, treatment may be rearrenged in case of aspirin resistance detected with empedance aggregometry device.
Description
Keywords
Koroner bypass, Aspirin direnci, İmpedans agregometri, Coronary by-pass, Aspirin resistance, Empedance aggregometry
Citation
Arslan, S. (2009). Koroner arter bypass greftleme sonrası aspirin direncinin greft tıkanması üzerine etkisi. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.