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, 04/18/2012

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.

Methods

  • 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).

Results

  • 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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