항혈소판제제에 노출된 체외순환 없는 관상동맥우회술을 시행받는 환자에서 hydroxyethyl starch 용액과 정질액 정주가 출혈량과 수혈량에 미치는 영향

Abstract

Background: Hydroxyethylstarch (HES) solutions are commonly used for intravascular volume expansion with varying effect on coagulation depending on molecular weight and mode of hydroxyl substitution. Clopidogrel and aspirin have been shown to reduce cardiovascular complications in patients with coronaryartery occlusive disease which renders patients to higher risk of bleeding complications who require surgery. The purpose of this study was to evaluate the effect of HES 200/0.5, 130/0.4 and crystalloid on blood loss and transfusion requirement in patients with recent antiplatelet therapy undergoing off-pump coronary bypass surgery (OPCAB) in a prospective, randomized trial. Methods: Sixty patients scheduled for OPCAB, who received clopidogrel and aspirin within 5 days of surgery were randomly allocated into 3 groups: HES 200/0.5 (n20), HES 150/0.4 (n20), and Crystalloid (n20). Routine coagulation profile were measured before and 2 days after the surgery. Amount of perioperative blood loss, transfusion requirement and fluids input and output were recorded until 2 days postoperatively. Results: The 3 groups were similar with regard to patients and operative characteristics. There were no significant differences in the amount of perioperative blood loss and transfusion requirement among the 3 groups. Conclusions: Both HES solutions were safe to use in terms of blood loss and transfusion requirement in patients undergoing OPCAB who received antiplatelet agents within 5 days of surgery