Influence of Hydroxyethyl Starch on Blood Coagulation of Patients after off-pump Coronary Artery Bypass Grafting by Thromboelastography_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENGQing-tao ¹ ,  WANGHui-shan ¹ , HANHong-guang ¹ , HANJin-song ¹ , LIXiao-mi ¹ , CHENZhao-hui ¹ , LUQin ²

1. Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command, Shenyang 110016, P. R. China;
2. Department of Cardiology, General Hospital of Shenyang Military Area Command, Shenyang 110016, P. R. China;

Corresponding?author：

WANGHui-shan, Email: huishanwang@hotmail.com

Keywords：

Hydroxyethyl starch; Thromboelastography; Coagulation; Off-pump coronary artery bypass grafting; Perioperative period

DOI：

10.7507/1007-4848.20140216

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Objective To investigate the influence of 6% hydroxyethyl starch (HES, 130/0.4)on blood coagulation of patients after off-pump coronary artery bypass grafting (opCAB)by thromboelastography (TEG). Methods One hundred patients undergoing elective opCAB in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Area Command between May and July 2013 were enrolled in this study. All the patients were randomly divided into 2 groups using random number table method with 50 patients in each group. In the experimental group (G1 group), there were 27 males and 23 females with their age of 64.9±4.4 years, who received intravenous 6% HES (130/0.4)20 ml/kg in 4 hours postoperatively. In the control group (G2 group), there were 31 males and 19 females with their age of 63.1±5.8 years, who received intravenous lactated ringers 20 ml/kg in 4 hours postoperatively. After postoperative ICU admission, full blood count, coagulation tests and TEG were examined. Chest and mediastinal drainage was recorded at 6 hours and 24 hours postoperatively. Results There was no statistical difference in chest and mediastinal drainage 24 hours postoperatively between the 2 groups (591.7±171.7 ml vs. 542.4±174.0 ml, P > 0.05). None of the patients received reexploration for bleeding. There was no statistical difference in hemoglobin, hematocrit, platelet count or traditional coagulation index between the 2 groups (P > 0.05). TEG showed no significant change in coagulation time after intravenous fluid infusion in either group. Reaction time was slightly extended in both groups, but there was no statistical difference in reaction time between the 2 groups (P > 0.05). Maximum amplitude (MA)of G1 group was significantly decreased after intravenous fluid infusion (55.9±10.0 mm vs. 62.8±7.9 mm, P < 0.05), but still within the normal range. There was no significant change in MA after intravenous fluid infusion in G2 group. Conclusion Intravenous infusion of 6% HES (130/0.4)20 ml/kg can reduce platelet function and clot strength, but does not significantly increase postoperative chest or mediastinal drainage, or the incidence of postoperative reexploration for bleeding. It's safe to administer 6% HES (130/0.4)for patients after OPCAB.

Citation： MENGQing-tao, WANGHui-shan, HANHong-guang, HANJin-song, LIXiao-mi, CHENZhao-hui, LUQin. Influence of Hydroxyethyl Starch on Blood Coagulation of Patients after off-pump Coronary Artery Bypass Grafting by Thromboelastography. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 753-757. doi: 10.7507/1007-4848.20140216 Copy

1.	Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med, 2012, 367(2):124-134.
2.	錢厚明, 黃成垠, 徐士云, 等.血小板凝血活性對預防性血小板輸注的預示價值研究.臨床檢驗雜志, 2009, 27(1):50-52.
3.	池一凡, 牛兆倬, 侯文明, 等.急性心肌梗死合并心源性休克手術治療六例.中國胸心血管外科臨床雜志, 2011, 18(1):77-79.
4.	Martin C, Jacob M, Vicaut E, et al. Effect of waxy maize-derived hydroxyethyl starch 130/0.4 on renal function in surgical patients. Anesthesiology, 2013, 118(2):387-394.
5.	Ioannidis JP. Meta-analyses of hydroxyethyl starch for volume resuscitation. JAMA, 2013, 309(21):2209.
6.	Staikou C, Paraskeva A, Fassoulaki A. The impact of 30 ml/kg hydroxyethyl starch 130/0.4 vs hydroxyethyl starch 130/0.42 on coagulation in patients undergoing abdominal surgery. Indian J Med Res, 2012, 136(3):445-450.
7.	Schaden E, Wetzel L, Kozek-Langenecker S, et al. Effect of the carrier solution for hydroxyethyl starch on platelet aggregation and clot formation. Br J Anaesth, 2012, 109(4):572-577.
8.	Witt L, Osthaus WA, Jahn W, et al. Isovolaemic hemodilution with gelatin and hydroxyethylstarch 130/0.42:effects on hemostasis in piglets. Paediatr Anaesth, 2012, 22(4):379-385.
9.	侯旭敏, 戴錦杰, 韓文正, 等.血栓彈力圖與活化凝血時間評價PCI術中普通肝素效果的比較研究.上海交通大學學報:醫學版, 2012, 32(11):1486-1489.
10.	Thai J, Reynolds EJ, Natalia N, et al. Comparison between RapidTEG^? and conventional thromboelastography in cardiac surgery patients. Br J Anaesth, 2011, 106(4):605-606.
11.	趙瑩, 胡森譯.早期創傷誘導凝血可能與血液稀釋和體液中凝血因子減少有關.中國危重病急救醫學, 2011, 23(6):358-358.
12.	楊麗君, 林茹, 葉莉芬, 等.血栓彈力圖在小兒體外循環圍術期的應用價值.中國體外循環雜志, 2013, 11(1):11-14.
13.	齊洛生, 楊宏富, 孫榮青, 等.嚴重外傷患者的凝血功能變化.中國危重病急救醫學, 2010, 22(6):379-380.
14.	Theusinger OM, Wanner GA, Emmert MY, et al. Hyperfibrinolysis diagnosed by rotational thromboelastometry(ROTEM)is associated with higher mortality in patients with severe trauma. Anesth Analg, 2011, 113(5):1003-1012.
15.	Banerjee A, Blois SL, Wood RD. Comparing citrated native, kaolin-activated, and tissue factor-activated samples and determining intraindividual variability for feline thromboelastography. J Vet.
16.	Diagn Invest, 2011, 23(6):1109-1113.
17.	Ko RH, Ji L, Young G. A novel approach for detecting hypercoagulability utilizing thromboelastography. Thromb Res, 2013, 131(4):352-356.
18.	Sadana N, Sparks L, Biggs D, et al. Perioperative management of a parturient with antithrombin deficiency and the role of thromboelastography. Int J Obstet Anesth, 2012, 21(3):287-288.
19.	張雪姣, 唐安麗, 廖新學, 等.可溶性血栓調節蛋白與冠心病患者短期預后的關系.中山大學學報:醫學科學版, 2006, 23(z1):135-137.
20.	楊海娜, 王偉, 盧紹禹, 等.血栓彈力圖(TEG)在冠心病凝血監測中的臨床應用.實用心腦肺血管病雜志, 2012, 20(9):1455-1457.
21.	Schochl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care, 2011, 15(6):265.
22.	Wohlauer MV, Moore EE, Thomas S, et al. Early platelet dysfunction:an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg, 2012, 214(5):739-746.
23.	管玉龍, 龍村.粘彈性凝血功能監測技術的應用及進展.中國胸心血管外科臨床雜志, 2009, 16(4):300-303.
24.	Rafiq S, Johansson PI, Ostrowski SR, et al. Hypercoagulability in patients undergoing coronary artery bypass grafting:prevalence, patient characteristics and postoperative outcome. Eur J Cardiothorac Surg, 2012, 41(3):550-555.
25.	Lee LV. Anticoagulants in coronary artery disease. Cardiol Clin, 2008, 26(4):615-628.
26.	Classen J, Adamik KN, Weber K, et al. In vitro effect of hydroxyethyl starch 130/0.42 on canine platelet function. Am J Vet Res, 2012, 73(12):1908-1912.

1. Perner A, Haase N, Guttormsen AB, et al. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med, 2012, 367(2):124-134.
2. 錢厚明, 黃成垠, 徐士云, 等.血小板凝血活性對預防性血小板輸注的預示價值研究.臨床檢驗雜志, 2009, 27(1):50-52.
3. 池一凡, 牛兆倬, 侯文明, 等.急性心肌梗死合并心源性休克手術治療六例.中國胸心血管外科臨床雜志, 2011, 18(1):77-79.
4. Martin C, Jacob M, Vicaut E, et al. Effect of waxy maize-derived hydroxyethyl starch 130/0.4 on renal function in surgical patients. Anesthesiology, 2013, 118(2):387-394.
5. Ioannidis JP. Meta-analyses of hydroxyethyl starch for volume resuscitation. JAMA, 2013, 309(21):2209.
6. Staikou C, Paraskeva A, Fassoulaki A. The impact of 30 ml/kg hydroxyethyl starch 130/0.4 vs hydroxyethyl starch 130/0.42 on coagulation in patients undergoing abdominal surgery. Indian J Med Res, 2012, 136(3):445-450.
7. Schaden E, Wetzel L, Kozek-Langenecker S, et al. Effect of the carrier solution for hydroxyethyl starch on platelet aggregation and clot formation. Br J Anaesth, 2012, 109(4):572-577.
8. Witt L, Osthaus WA, Jahn W, et al. Isovolaemic hemodilution with gelatin and hydroxyethylstarch 130/0.42:effects on hemostasis in piglets. Paediatr Anaesth, 2012, 22(4):379-385.
9. 侯旭敏, 戴錦杰, 韓文正, 等.血栓彈力圖與活化凝血時間評價PCI術中普通肝素效果的比較研究.上海交通大學學報:醫學版, 2012, 32(11):1486-1489.
10. Thai J, Reynolds EJ, Natalia N, et al. Comparison between RapidTEG^? and conventional thromboelastography in cardiac surgery patients. Br J Anaesth, 2011, 106(4):605-606.
11. 趙瑩, 胡森譯.早期創傷誘導凝血可能與血液稀釋和體液中凝血因子減少有關.中國危重病急救醫學, 2011, 23(6):358-358.
12. 楊麗君, 林茹, 葉莉芬, 等.血栓彈力圖在小兒體外循環圍術期的應用價值.中國體外循環雜志, 2013, 11(1):11-14.
13. 齊洛生, 楊宏富, 孫榮青, 等.嚴重外傷患者的凝血功能變化.中國危重病急救醫學, 2010, 22(6):379-380.
14. Theusinger OM, Wanner GA, Emmert MY, et al. Hyperfibrinolysis diagnosed by rotational thromboelastometry(ROTEM)is associated with higher mortality in patients with severe trauma. Anesth Analg, 2011, 113(5):1003-1012.
15. Banerjee A, Blois SL, Wood RD. Comparing citrated native, kaolin-activated, and tissue factor-activated samples and determining intraindividual variability for feline thromboelastography. J Vet.
16. Diagn Invest, 2011, 23(6):1109-1113.
17. Ko RH, Ji L, Young G. A novel approach for detecting hypercoagulability utilizing thromboelastography. Thromb Res, 2013, 131(4):352-356.
18. Sadana N, Sparks L, Biggs D, et al. Perioperative management of a parturient with antithrombin deficiency and the role of thromboelastography. Int J Obstet Anesth, 2012, 21(3):287-288.
19. 張雪姣, 唐安麗, 廖新學, 等.可溶性血栓調節蛋白與冠心病患者短期預后的關系.中山大學學報:醫學科學版, 2006, 23(z1):135-137.
20. 楊海娜, 王偉, 盧紹禹, 等.血栓彈力圖(TEG)在冠心病凝血監測中的臨床應用.實用心腦肺血管病雜志, 2012, 20(9):1455-1457.
21. Schochl H, Cotton B, Inaba K, et al. FIBTEM provides early prediction of massive transfusion in trauma. Crit Care, 2011, 15(6):265.
22. Wohlauer MV, Moore EE, Thomas S, et al. Early platelet dysfunction:an unrecognized role in the acute coagulopathy of trauma. J Am Coll Surg, 2012, 214(5):739-746.
23. 管玉龍, 龍村.粘彈性凝血功能監測技術的應用及進展.中國胸心血管外科臨床雜志, 2009, 16(4):300-303.
24. Rafiq S, Johansson PI, Ostrowski SR, et al. Hypercoagulability in patients undergoing coronary artery bypass grafting:prevalence, patient characteristics and postoperative outcome. Eur J Cardiothorac Surg, 2012, 41(3):550-555.
25. Lee LV. Anticoagulants in coronary artery disease. Cardiol Clin, 2008, 26(4):615-628.
26. Classen J, Adamik KN, Weber K, et al. In vitro effect of hydroxyethyl starch 130/0.42 on canine platelet function. Am J Vet Res, 2012, 73(12):1908-1912.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Influence of Hydroxyethyl Starch on Blood Coagulation of Patients after off-pump Coronary Artery Bypass Grafting by Thromboelastography

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