В обзоре литературы описываются риски и польза от проведения оперативных вмешательств у пациентов, получающих антитромбоцитарную терапию без отмены ацетилсалициловой кислоты в предоперационном периоде. Приводятся данные, подтверждающие умеренное повышение риска периоперационных кровотечений в случаях, когда операции проводятся на фоне аспиринотерапии. В то же время в большинстве случаев отмечаются значительное снижение риска периоперационных кардиоваскулярных событий и повышение выживаемости после вмешательств, перед которыми не происходит отмена препаратов ацетилсалициловой кислоты.
In a review, we described risks and benefits of surgery performed while continuing aspirin therapy in perioperative period. Aspirin therapy is associated with mild increase in surgery related bleeding risk. On the other hand, aspirin therapy leads to significant decrease of mortality and perioperative cardiovascular risk in most cases.
1. Roffi M, Patrono C, Collet J-P et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. EHJ 2015. doi: 10.1093/eurheartj/ehv320
2. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–84.
3. Mangano DT. Perioperative cardiovascular morbidity: new developments. Best Pract Res Clin Anaesthesiol 1999; 13 (3): 335–48.
4. Vicenzi MN, Meislitzer T, Heitzinger B et al. Coronary artery stenting and non-cardiac surgery – a prospective outcome study. Br J Anaesth 2006; 96: 686–93.
5. Iakovou I, Schmidt T, Bonizzoni E et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. J Am Med Assoc 2005; 293: 2126–30.
6. Patrono C, Baigent C, Hirsh J et al. Аntiplatelet Drugs. Chest 2008; 133 (6 Suppl.): 199S–233S.
7. Awtry EH, Loscalzo J. Aspirin. Circulation 2000; 101: 1206–18.
8. Jimenez AH, Stubbs ME, Tofler GH et al. Rapidity and duration of platelet suppression by entericcoated aspirin in healthy young men. Am J Cardiol 1992; 69: 258–62.
9. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.
10. Hall R, Mazer CD. Antiplatelet drugs: a review of their pharmacology and management in the perioperative period. Anesth Analg 2011; 112: 292–318.
11. Collaborative overview of randomised trials of antiplatelet therapy – I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ 1994; 308: 81–106.
12. Baigent C, Blackwell L, Collins R et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849–60.
13. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). EHJ 2012; 33: 1635–701.
14. Amsterdam EA, Wenger NK, Brindis RG et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Circulation 2014; 130: e344–e426.
15. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation 2013; 127: e362–e425.
16. Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. JACC 2012; 60 (24): e44–e164.
17. Brott TG, Halperin JL, Abbara S et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. Circulation 2011; 124: e54–e130.
18. Rooke TW, Hirsch AT, Misra S et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). Circulation 2011; 124: 2020–45.
19. Burger W, Chemnitius JM, Kneissl GD et al. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 2005; 257: 399–414.
20. Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994; 35: 1061–4.
21. Oscarsson A, Gupta A, Fredrikson M et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 2010; 104: 305–12.
22. Kaluza GL, Joseph J, Lee JR et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. JACC 2000; 35: 1288–94.
23. Sharma AK, Ajani AE, Hamwi SM et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004; 63: 141–5.
24. Biondi-Zoccai GG, Lotrionte M, Agostoni P et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. EHJ 2006; 27: 2667–74.
25. Collet JP, Himbert F, Steg PG. Myocardial infarction after aspirin cessation in stable coronary artery disease patients. Int J Cardiol 2000; 76: 257–8.
26. Collet JP, Montalescot G, Balnchet B et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 2004; 110: 2361–7.
27. Ferrari E, Benhamou M, Cerboni P et al. Coronary syndromes following aspirin withdrawal, a special risk for late stent thrombosis. JACC 2005; 45: 456–9.
28. Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol 2005; 62 (8): 1217–20.
29. Sung JJ, Lau JY, Ching JY et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9.
30. Madan GA, Madan SG, Madan G et al. Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients. J Oral Maxillofac Surg 2005; 63: 1262–5.
31. Chu MB, Turner RB, Kriegel DA. Patients with drug-eluting stents and management of their anticoagulant therapy in cutaneous surgery. J Am Acad Dermatol 2011; 64: 553–8.
32. Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg 2004; 30: 1091–4.
33. Cook-Norris RH, Michaels JD, Weaver AL et al. Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation. J Am Acad Dermatol 2011; 65: 584–91.
34. Douketis JD, Spyropoulos AC, Spencer FA et al. Perioperative Management of Antithrombotic Therapy. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141 (2 Suppl.): e326S–e350S.
35. Manocha D, Singh M, Mehta N et al. Bleeding Risk after Invasive Procedures in Aspirin/NSAID Users: Polypectomy Study in Veterans. Am J Med 2012; 125: 1222–7.
36. Yousfi M, Gostout CJ, Baron TH et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol 2004; 99: 1785–9.
37. Hui AJ, Wong RM, Ching JY et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 2004; 59: 44–8.
38. Anderson MA, Ben-Menachem T, Gan SI et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060–70.
39. Lindblad B, Persson NH, Takolander R et al. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double blind, placebo-controlled randomized trial. Stroke 1993; 24: 1125–8.
40. Neilipovitz DT, Bryson GL, Nichol G. The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. Anesth Analg 2001; 93: 573–80.
41. Rosenbaum A, Rizvi AZ, Alden PB et al. Outcomes related to antiplatelet or anticoagulation use in patients undergoing carotid endarterectomy. Ann Vasc Surg 2011; 25: 25–31.
42. Burdess A, Nimmo AF, Garden OJ et al. Randomized controlled trial of dual antiplatelet therapy in patients undergoing surgery for critical limb ischemia. Ann Surg 2010; 252: 37–42.
43. Eng M, Brock G, Li X et al. Perioperative anticoagulation and antiplatelet therapy in renal transplant: is there an increase in bleeding complication? Clin Transplant 2011; 25: 292–6.
44. Giannarini G, Mogorovich A, Valent F et al. Continuing or discontinuing low-dose aspirin before transrectal prostate biopsy: results of a prospective randomized trial. Urology 2007; 70: 501–5.
45. Halliwell OT, Yadegafar G, Lane C et al. Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications. Clin Radiol 2008; 63: 557–61.
46. Thurston AV, Briant SL. Aspirin and post-prostatectomy haemorrhage. Br J Urol 1993; 71: 574–6.
47. Wierod FS, Frandsen NJ, Jacobsen JD et al. Risk of haemorrhage from transurethral prostatectomy in acetylsalicylic acid and NSAID-treated patients. Scand J Urol Nephrol 1998; 32: 120–2.
48. Nielsen JD, Holm-Nielsen A, Jespersen J et al. The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy – a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol 2000; 34: 194–8.
49. Ala-Opas MY, Gronlund SS. Blood loss in long-term aspirin users undergoing transurethral prostatectomy. Scand J Urol Nephrol 1996; 30: 203–6.
50. Ferraris VA, Swanson E. Aspirin usage and perioperative blood loss in patients undergoing unexpected operations. Surg Gynecol Obstet 1983; 156: 439–42.
51. Ott MM, Eriksson E, Vanderkolk W et al. Antiplatelet and anticoagulation therapies do not increase mortality in the absence of traumatic brain injury. J Trauma 2010; 68: 560–3.
52. Manning BJ, O’Brien N, Aravindan S et al. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures. Injury 2004; 35: 121–4.
53. Anekstein Y, Tamir E, Halperin N et al. Aspirin therapy and bleeding during proximal femoral fracture surgery. Clin Orthop Relat Res 2004; 418: 205–8.
54. Edmunds I, Avakian Z. Hand surgery on anticoagulated patients: a prospective study of 121 operations. Hand Surg 2010; 15: 109–13.
55. Devereaux PJ, Mrkobrada M, Sessler DI et al. Aspirin in Patients Undergoing Noncardiac Surgery. N Engl J Med 2014; 370 (16): 1494–503.
56. Fleisher LA, Fleischmann KE, Auerbach AD et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. Circulation 2014; 130: 2215–45.
57. Ghaffarinejad MH, Fazelifar AF, Shirvani SM et al. The effect of preoperative aspirin use on postoperative bleeding and perioperative myocardial infarction in patients undergoing coronary artery bypass surgery. Cardiol J 2007; 14: 453–7.
58. Srinivasan AK, Grayson AD, Pullan DM et al. Effect of preoperative aspirin use in off-pump coronary artery bypass operations. Ann Thorac Surg 2003; 76: 41–5.
59. Sun JC, Crowther MA, Warkentin TE et al. Should aspirin be discontinued before coronary artery bypass surgery? Circulation 2005; 112: e85–e90.
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67. Weil J, Colin-Jones D, Langman M et al. Prophylactic aspirin and risk of peptic ulcer bleeding. BMJ 1995; 310: 827–30.
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69. Weisman SM, Graham DY. Evaluation of the Benefits and Risks of Low-Dose Aspirin in the Secondary Prevention of Cardiovascular and Cerebrovascular Events. Arch Intern Med 2002; 162: 2197–202.
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1. Roffi M, Patrono C, Collet J-P et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. EHJ 2015. doi: 10.1093/eurheartj/ehv320
2. Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153–84.
3. Mangano DT. Perioperative cardiovascular morbidity: new developments. Best Pract Res Clin Anaesthesiol 1999; 13 (3): 335–48.
4. Vicenzi MN, Meislitzer T, Heitzinger B et al. Coronary artery stenting and non-cardiac surgery – a prospective outcome study. Br J Anaesth 2006; 96: 686–93.
5. Iakovou I, Schmidt T, Bonizzoni E et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. J Am Med Assoc 2005; 293: 2126–30.
6. Patrono C, Baigent C, Hirsh J et al. Аntiplatelet Drugs. Chest 2008; 133 (6 Suppl.): 199S–233S.
7. Awtry EH, Loscalzo J. Aspirin. Circulation 2000; 101: 1206–18.
8. Jimenez AH, Stubbs ME, Tofler GH et al. Rapidity and duration of platelet suppression by entericcoated aspirin in healthy young men. Am J Cardiol 1992; 69: 258–62.
9. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71–86.
10. Hall R, Mazer CD. Antiplatelet drugs: a review of their pharmacology and management in the perioperative period. Anesth Analg 2011; 112: 292–318.
11. Collaborative overview of randomised trials of antiplatelet therapy – I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration. BMJ 1994; 308: 81–106.
12. Baigent C, Blackwell L, Collins R et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373: 1849–60.
13. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). EHJ 2012; 33: 1635–701.
14. Amsterdam EA, Wenger NK, Brindis RG et al. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes. Circulation 2014; 130: e344–e426.
15. O’Gara PT, Kushner FG, Ascheim DD et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation 2013; 127: e362–e425.
16. Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. JACC 2012; 60 (24): e44–e164.
17. Brott TG, Halperin JL, Abbara S et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. Circulation 2011; 124: e54–e130.
18. Rooke TW, Hirsch AT, Misra S et al. 2011 ACCF/AHA Focused Update of the Guideline for the Management of Patients With Peripheral Artery Disease (Updating the 2005 Guideline). Circulation 2011; 124: 2020–45.
19. Burger W, Chemnitius JM, Kneissl GD et al. Low-dose aspirin for secondary cardiovascular prevention – cardiovascular risks after its perioperative withdrawal versus bleeding risks with its continuation – review and meta-analysis. J Intern Med 2005; 257: 399–414.
20. Palmer JD, Sparrow OC, Iannotti F. Postoperative hematoma: a 5-year survey and identification of avoidable risk factors. Neurosurgery 1994; 35: 1061–4.
21. Oscarsson A, Gupta A, Fredrikson M et al. To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial. Br J Anaesth 2010; 104: 305–12.
22. Kaluza GL, Joseph J, Lee JR et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. JACC 2000; 35: 1288–94.
23. Sharma AK, Ajani AE, Hamwi SM et al. Major noncardiac surgery following coronary stenting: when is it safe to operate? Catheter Cardiovasc Interv 2004; 63: 141–5.
24. Biondi-Zoccai GG, Lotrionte M, Agostoni P et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50,279 patients at risk for coronary artery disease. EHJ 2006; 27: 2667–74.
25. Collet JP, Himbert F, Steg PG. Myocardial infarction after aspirin cessation in stable coronary artery disease patients. Int J Cardiol 2000; 76: 257–8.
26. Collet JP, Montalescot G, Balnchet B et al. Impact of prior use or recent withdrawal of oral antiplatelet agents on acute coronary syndromes. Circulation 2004; 110: 2361–7.
27. Ferrari E, Benhamou M, Cerboni P et al. Coronary syndromes following aspirin withdrawal, a special risk for late stent thrombosis. JACC 2005; 45: 456–9.
28. Maulaz AB, Bezerra DC, Michel P, Bogousslavsky J. Effect of discontinuing aspirin therapy on the risk of brain ischemic stroke. Arch Neurol 2005; 62 (8): 1217–20.
29. Sung JJ, Lau JY, Ching JY et al. Continuation of low-dose aspirin therapy in peptic ulcer bleeding: a randomized trial. Ann Intern Med 2010; 152: 1–9.
30. Madan GA, Madan SG, Madan G et al. Minor oral surgery without stopping daily low-dose aspirin therapy: a study of 51 patients. J Oral Maxillofac Surg 2005; 63: 1262–5.
31. Chu MB, Turner RB, Kriegel DA. Patients with drug-eluting stents and management of their anticoagulant therapy in cutaneous surgery. J Am Acad Dermatol 2011; 64: 553–8.
32. Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg 2004; 30: 1091–4.
33. Cook-Norris RH, Michaels JD, Weaver AL et al. Complications of cutaneous surgery in patients taking clopidogrel-containing anticoagulation. J Am Acad Dermatol 2011; 65: 584–91.
34. Douketis JD, Spyropoulos AC, Spencer FA et al. Perioperative Management of Antithrombotic Therapy. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141 (2 Suppl.): e326S–e350S.
35. Manocha D, Singh M, Mehta N et al. Bleeding Risk after Invasive Procedures in Aspirin/NSAID Users: Polypectomy Study in Veterans. Am J Med 2012; 125: 1222–7.
36. Yousfi M, Gostout CJ, Baron TH et al. Postpolypectomy lower gastrointestinal bleeding: potential role of aspirin. Am J Gastroenterol 2004; 99: 1785–9.
37. Hui AJ, Wong RM, Ching JY et al. Risk of colonoscopic polypectomy bleeding with anticoagulants and antiplatelet agents: analysis of 1657 cases. Gastrointest Endosc 2004; 59: 44–8.
38. Anderson MA, Ben-Menachem T, Gan SI et al. Management of antithrombotic agents for endoscopic procedures. Gastrointest Endosc 2009; 70: 1060–70.
39. Lindblad B, Persson NH, Takolander R et al. Does low-dose acetylsalicylic acid prevent stroke after carotid surgery? A double blind, placebo-controlled randomized trial. Stroke 1993; 24: 1125–8.
40. Neilipovitz DT, Bryson GL, Nichol G. The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis. Anesth Analg 2001; 93: 573–80.
41. Rosenbaum A, Rizvi AZ, Alden PB et al. Outcomes related to antiplatelet or anticoagulation use in patients undergoing carotid endarterectomy. Ann Vasc Surg 2011; 25: 25–31.
42. Burdess A, Nimmo AF, Garden OJ et al. Randomized controlled trial of dual antiplatelet therapy in patients undergoing surgery for critical limb ischemia. Ann Surg 2010; 252: 37–42.
43. Eng M, Brock G, Li X et al. Perioperative anticoagulation and antiplatelet therapy in renal transplant: is there an increase in bleeding complication? Clin Transplant 2011; 25: 292–6.
44. Giannarini G, Mogorovich A, Valent F et al. Continuing or discontinuing low-dose aspirin before transrectal prostate biopsy: results of a prospective randomized trial. Urology 2007; 70: 501–5.
45. Halliwell OT, Yadegafar G, Lane C et al. Transrectal ultrasound-guided biopsy of the prostate: aspirin increases the incidence of minor bleeding complications. Clin Radiol 2008; 63: 557–61.
46. Thurston AV, Briant SL. Aspirin and post-prostatectomy haemorrhage. Br J Urol 1993; 71: 574–6.
47. Wierod FS, Frandsen NJ, Jacobsen JD et al. Risk of haemorrhage from transurethral prostatectomy in acetylsalicylic acid and NSAID-treated patients. Scand J Urol Nephrol 1998; 32: 120–2.
48. Nielsen JD, Holm-Nielsen A, Jespersen J et al. The effect of low-dose acetylsalicylic acid on bleeding after transurethral prostatectomy – a prospective, randomized, double-blind, placebo-controlled study. Scand J Urol Nephrol 2000; 34: 194–8.
49. Ala-Opas MY, Gronlund SS. Blood loss in long-term aspirin users undergoing transurethral prostatectomy. Scand J Urol Nephrol 1996; 30: 203–6.
50. Ferraris VA, Swanson E. Aspirin usage and perioperative blood loss in patients undergoing unexpected operations. Surg Gynecol Obstet 1983; 156: 439–42.
51. Ott MM, Eriksson E, Vanderkolk W et al. Antiplatelet and anticoagulation therapies do not increase mortality in the absence of traumatic brain injury. J Trauma 2010; 68: 560–3.
52. Manning BJ, O’Brien N, Aravindan S et al. The effect of aspirin on blood loss and transfusion requirements in patients with femoral neck fractures. Injury 2004; 35: 121–4.
53. Anekstein Y, Tamir E, Halperin N et al. Aspirin therapy and bleeding during proximal femoral fracture surgery. Clin Orthop Relat Res 2004; 418: 205–8.
54. Edmunds I, Avakian Z. Hand surgery on anticoagulated patients: a prospective study of 121 operations. Hand Surg 2010; 15: 109–13.
55. Devereaux PJ, Mrkobrada M, Sessler DI et al. Aspirin in Patients Undergoing Noncardiac Surgery. N Engl J Med 2014; 370 (16): 1494–503.
56. Fleisher LA, Fleischmann KE, Auerbach AD et al. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary. Circulation 2014; 130: 2215–45.
57. Ghaffarinejad MH, Fazelifar AF, Shirvani SM et al. The effect of preoperative aspirin use on postoperative bleeding and perioperative myocardial infarction in patients undergoing coronary artery bypass surgery. Cardiol J 2007; 14: 453–7.
58. Srinivasan AK, Grayson AD, Pullan DM et al. Effect of preoperative aspirin use in off-pump coronary artery bypass operations. Ann Thorac Surg 2003; 76: 41–5.
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Авторы
С.С.Алтарев*, О.Л.Барбараш
ФГБНУ НИИ комплексных проблем сердечно-сосудистых заболеваний. 650002, Россия, Кемерово, Сосновый б-р, д. 6
*altarev@inbox.ru
________________________________________________
S.S.Altarev*, O.L.Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases. 650002, Russian Federation, Kemerovo, Sosnovyi b-r, d. 6
*altarev@inbox.ru