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Effect of hydroxyethyl starch 130/0.4 on blood loss and coagulation in patients with recent exposure to dual antiplatelet therapy undergoing off-pump coronary artery bypass graft surgery

Authors
 Jeong Soo Lee  ;  So Woon Ahn  ;  Jong Wook Song  ;  Jae Kwang Shim  ;  Kyung-Jong Yoo  ;  Young Lan Kwak 
Citation
 CIRCULATION JOURNAL, Vol.75(10) : 2397-2402, 2011 
Journal Title
CIRCULATION JOURNAL
ISSN
 1346-9843 
Issue Date
2011
MeSH
Aged ; Aspirin/therapeutic use ; Blood Coagulation/drug effects* ; Blood Loss, Surgical/prevention & control* ; Coronary Artery Bypass, Off-Pump/adverse effects* ; Female ; Hemoglobins/analysis ; Hemorrhage/prevention & control ; Humans ; Hydroxyethyl Starch Derivatives/administration & dosage ; Hydroxyethyl Starch Derivatives/pharmacology* ; Isotonic Solutions ; Male ; Middle Aged ; Perioperative Care ; Plasma Substitutes ; Platelet Aggregation Inhibitors ; Ticlopidine/analogs & derivatives ; Ticlopidine/therapeutic use ; Treatment Outcome
Keywords
Aspirin ; Clopidogrel ; Coagulation ; 6% Hydroxyethyl ; Hydroxyethyl starch 130/0.4 ; Off-pump coronary artery bypass surgery
Abstract
BACKGROUND: Hydroxyethyl starch (HES) solutions are often used for maintaining intravascular volume and improving microperfusion, while a large amount of HES can cause adverse effects on coagulation. As the indications for clopidogrel expand, an increasing number of patients undergoing off-pump coronary artery bypass surgery (OPCAB) are also undergoing dual antiplatelet therapy (DAPT), with its higher risk of bleeding complications. The aim of the present study was to determine whether a moderate dose of 6% HES 130/0.4 significantly increases perioperative blood loss in patients with continued DAPT within 5 days of OPCAB.

METHODS AND RESULTS: Patients who received clopidogrel and aspirin within 5 days of OPCAB were randomly allocated to receive HES 130/0.4 (≤ 30 ml/kg) followed by crystalloid infusion (HES group, n=53), or crystalloid only (crystalloid group, n=53) perioperatively. The amount of perioperative blood loss (sum of bleeding during the intraoperative and postoperative 24-h period), transfusion requirements, modified thromboelastography and coagulation variables, hemodynamic parameters, and fluid balance were recorded. Perioperative blood loss and coagulation profiles were similar between the groups, but the postoperative hemoglobin level was higher in the crystalloid group.

CONCLUSIONS: Up to 30 ml·kg⁻¹·day⁻¹ of 6% HES 130/0.4 did not increase the perioperative blood loss compared to crystalloid in patients with recent exposure to DAPT undergoing OPCAB. HES 130/0.4 caused a similar degree and duration of coagulation impairment as observed when only crystalloid was given.
Files in This Item:
T201103362.pdf Download
DOI
10.1253/circj.CJ-11-0404
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Song, Jong Wook(송종욱) ORCID logo https://orcid.org/0000-0001-7518-2070
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
Lee, Jeong Soo(이정수) ORCID logo https://orcid.org/0000-0002-8947-3706
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/94232
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