Perioperative Use of Antiplatelet Therapy in Coronary Artery Bypass Graft
|School||Hebei Medical University|
|Keywords||Coronary artery bypass grafting Antiplatelet drugs Aspirin Clopidogrel Platelet glycoprotein Ⅱ b / Ⅲ a receptor antagonist|
Coronary artery bypass grafting (Coronary artery bypass graft surgery, CABG) is the effective clinical methods for treating coronary heart disease, can effectively alleviate the patient's angina, improve myocardial blood supply, to avoid the occurrence of myocardial infarction, improve quality of life and prolonging life . Antiplatelet therapy in coronary artery bypass surgery is the cornerstone to prevent thrombosis, have an important role to maintain the patency of the vein bypass and prevention of cardiovascular events. Representative drugs that inhibit platelet metabolism of aspirin in preventing thrombosis in a variety of disease having a wide range of applications. The main pharmacological effect of aspirin is irreversible inhibition of cyclooxygenase, thus blocking platelet arachidonic acid metabolic pathway, inhibition of thromboxane A2 (TXA2) formation, thereby inhibiting platelet aggregation and prevent thrombosis. The main pharmacological effects of clopidogrel is selective inhibition of the platelet surface and the adenylate cyclase-coupled ADP (adenosine diphosphate, ADP) ADP receptor, thereby inhibiting fibrinogen binding to platelets, and through successively blocked by the release of ADP-induced platelet activation, thereby irreversibly inhibiting platelet the mutual aggregation . Clopidogrel also has a role to prevent intimal thickening . The platelet sugar protein Ⅱ b / Ⅲ a (Platelet glycoprotein IIb / III a, GP Ⅱ b / Ⅲ a) receptor antagonistic drug can significantly block the platelet surface of GP Ⅱ b / Ⅲ a receptor, thereby inhibiting platelet aggregation inhibition of platelet cross-linking caused by clotting factor. GP Ⅱ b / Ⅲ a receptor antagonistic drug effects the target is the final stage of platelet aggregation, can significantly reduce the number and function of a of the functionality of the platelet surface GP Ⅱ b / Ⅲ receptors, blocking the GP IIb / IIIa receptor and clotting factor of the combination, thereby inhibition of platelet aggregation. The mechanism of action of the above three types of anti-platelet drugs antagonize platelet function, its clinical application, dose, time, route of administration with different characteristics, but also each have different weaknesses and limitations of the application. Therefore, how to make better, more rational use of three types of anti-platelet drugs in order to obtain the maximum clinical benefit, has become the current clinical needs further study and confirmed. Antiplatelet drugs as a coronary artery bypass graft the cornerstone of antithrombotic therapy, its role is irreplaceable. Aspirin and clopidogrel in the treatment of coronary heart disease has been generally recognized, a lot of research experiments also confirmed in coronary artery bypass surgery perioperative antithrombotic and maintain vein bypass patency both played an important role . Platelet membrane GP Ⅱ b / Ⅲ a receptor antagonists as a new generation of anti-platelet drugs, with a more powerful anti-thrombosis, coronary artery bypass surgery preoperative and postoperative prevention of thrombosis has good application prospects. But, how more effective, more reasonable application of platelet GP Ⅱ b / IIIa receptor antagonist drug has yet to be further large-scale clinical trials research.