A randomized prospective analysis of alteration of hemostatic function in patients receiving tranexamic acid and hydroxyethyl starch (130/0.4) undergoing off pump coronary artery bypass surgery
Annals of Cardiac Anaesthesia, 04/18/2012Chakravarthy M et al.
Concomitant use of tranexamic acid (TA) with hydroxyl ethyl starch (HES) appears to reverse these changes without causing any adverse effects in patients undergoing OPCAB surgery.
Thromboelastogram (TEG) was used to assess the effect of the combination of HES and TA.
With ethical committee approval and patient's consent, 100 consecutive patients were recruited for the study.
Surgical and anesthetic techniques were standardized
Patients fulfilling the inclusion criteria were randomly allocated into 4 groups of 25 each.
The patients in group A received 20ml/kg of HES (130/0.4), 10mg/kg of T.A over 30minutes followed by infusion of 1mg/kg/hr over the next 12hrs.
The patients in group B received Ringer's lactate+TA at same dose.
The patients in the Group C received 20ml/kg of HES.
Group D patients received RL.
Fluid therapy was goal directed.
Total blood loss was assessed.
Reaction time (r), α angle, maximum amplitude (MA) values of TEG were assessed at baseline, 12, 36hrs.
The possible perioperative myocardial infraction (MI) was assessed by electrocardiogram (ECG) and troponin T values at the baseline, postoperative day 1.
Duration on ventilator, length of stay (LOS) in the intensive care unit (ICU) were also assessed.
The demographical profile was similar among the groups.
Use of HES increased blood loss significantly (P<0.05).
Concomitant use of TA reduced blood loss when used along with HES.
r value was prolonged at 12hours in all the groups and α angle was reduced at 12hours in all the groups, where as MA value was reduced at 12th hour in the HES group compared to the baseline and increased in TA + HES group.
These findings were statistically significant.
No significant change in Troponin T values/ ECG, duration of ventilation and LOS ICU was observed.
No adverse events was noticed in any of the four groups. HES (130/0.4) used at a dose of 20ml/kg seems to produce coagulopathy causing increased blood loss perioperatively.
Hemodilution produced by fluid therapy seems to produce Coagulopathy as observed by TEG parameters.
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