ABSTRACT
Objective To evaluate the effect of time of discontinuing clopidogrel administration be-fore operation on blood-saving effect of tranexamic acid. Methods One hundred and eighty patients of both sexes, aged 18-70 yr, weighing 45-85 kg, scheduled for elective first coronary artery bypass grafting under cardiopulmonary bypass, were divided into A, B and C groups(n=60 each)according to clopi-dogrel use before operation. In group A, clopidogrel 75 mg∕d was taken orally, and time of stopping clopi-dogrel administration before operation <7 days. In group B, clopidogrel 75 mg∕d was taken orally, and time of stopping use of clopidogrel before operation≥7 days. Patients received no clopidogrel before opera-tion in group C. After induction of anesthesia, tranexamic acid was infused at a loading dose of 10 mg∕kg o-ver 20 min, followed by an infusion of 10 mg·kg-1·h-1until the end of operation. Blood loss and re-quirement for allogeneic erythrocytes,plasma and platelet were recorded before removal of drainage tubes af-ter operation. The dose of heparin and protamine was recorded. The development of perioperative adverse reactions was also recorded. Results There was no significant change in the amount of heparin and prota-mine, ratio of protamine to heparin for heparin neutralization or incidence of perioperative adverse reactions between the three groups(P>0.05). Compared with group C, the incidence of major bleeding, transfusion of and requirement for allogeneic erythrocytes, plasma and platelets were significantly increased in group A (P<0.05), and no significant change was found in the parameters mentioned above in group B(P>0.05). There was no significant difference in postoperative blood loss or transfusion of allogeneic erythrocytes, plas-ma and platelets between group B and group A(P>0.05). Conclusion The time of discontinuing clopi-dogrel administration before operation exerts no effect on blood-saving effect of tranexamic acid.
ABSTRACT
Objective To investigate the effects of special anticoagulation method of hybrid coronary revascularization procedure on postoperative bleeding and clinical outcomes.Methods One hundred and forty-one ASA Ⅱ or Ⅲ consecutive patients,aged 35-82 yr,weighing 45-105 kg,undergoing one-stop hybrid coronary revascularization procedure from June 2007 to January 2011 in Fuwai cardiovascular hospital were enrolled and served as Hybrid group.Using propensity score methodology,these patients were matched with another 141 patients who had undergone off-pump coronary artery bypass grafting (OPCAB group) during the same period,selecting from the surgical database.These ASAⅡ or Ⅲ 141 patients,aged 43-80 yr,weighing 47-110 kg,who underwent OPCAB,were served as control subjects.In group Hybrid,the left internal mammary artery was isolated and then 100-120 U/kg heparin was administrated to maintain activated clotting time between 250-300 s,and additional heparin was given if needed.Protamine 1 mg/kg was used to reverse the effect of heparin after anastomosis between left internal mammary artery and left anterior descending branch.Before stent implantation,6000-8000 U heparin and 300 mg clopidogrel were administrated.Activated clotting time was maintained between 200-250 s until the end of operation.Clopidogrel 75 mg/d was taken for at least 12 months after operation.The volume of postoperative chest tube drainage,mechanical ventilation time,length of stay in intensive care unit,postoperative transfusion of allogeneic blood,re-intubation,myocardial damage,acute kidney injury,atelectasis,hydrothorax and thromboembolism were recorded.Results No thromboembolism was observed within the stent during stay in hospital after operation in patients.The volume of chest tube drainage was significantly less,mechanical ventilation time and length of stay in intensive care unit were shorter,the incidence of atelectasis and hydrothorax and transfusion of allogeneic blood requirement were lower in Hybrid group than in OPCAB group (P ＜ 0.05).There was no significant difference in the incidences of re-intubation,myocardio damage,and acute kidney injury between the two groups (P ＞0.05).Conclusion Special anticoagulation method of hybrid coronary revascularization procedure does not increase postoperative bleeding and has a better clinical outcomes during the early period.
ABSTRACT
ObjectiveTo investigate the effect of tranexamic acid on inflammatory response in patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods Sixty ASA Ⅰ -Ⅲ and NYHA Ⅰ -Ⅲ patients of both sexes,aged 45-64 yr,with body mass index 16-22 kg/m2,undergoing elective OPCABG,were randomly divided into 2 groups ( n =30 each):control group (group C) and tranexamic acid group (group T).Anesthesia was induced with iv injection of midazolam,fentanyl and pipecuronium.The patients were tracheal intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.Tranexamic acid 1 g was infused intravenously over 30 min after induction followed by continuous infusion at 400 mg/h until the end of operation in group T.While equal volume of normal saline was given in gtoup C.Anesthesia was maintained with inhalation of isoflurane and intermittent (i)v boluses of fentanyl and pipecuroninm.Venous blood samples were taken before induction,at the end of operation and 24 h after operation for determination of Hb,platelet count,prothrombin time,international normalized ratio and plasma D-dimer and IL-6 concentrations.The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation.The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was recorded.The complications during hospital stay were also recorded.ResultsCompared with group C,the plasma concentrations of D-dimer and IL-6 were significantly decreased at the end of operation and 24 h after operation,and the volume of chest tube drainage and the requirement for transfusion of allogeneic red blood cells and fresh frozen plasma were significantly decreased after operation in group T ( P ＜ 0.05 or 0.01).There was no significant difference in Hb,platelet count,prothrombin time and international normalized ratio between the two groups (P ＞ 0.05).No complications occurred during hospital stay in the two groups.ConclusionTranexamic acid can reduce inflammatory response in patients undergoing OPCABG.