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

Jeong Soo Lee, So Woon Ahn, Jong Wook Song, Jae Kwang Shim, Kyung Jong Yoo, Younglan Kwak

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)2397-2402
Number of pages6
JournalCirculation Journal
Volume75
Issue number10
DOIs
Publication statusPublished - 2011 Oct 1

Fingerprint

Hydroxyethyl Starch Derivatives
Off-Pump Coronary Artery Bypass
Blood Coagulation
Coronary Artery Bypass
clopidogrel
Transplants
Starch
Therapeutics
Hemorrhage
Thrombelastography
Water-Electrolyte Balance
Aspirin
crystalloid solutions
Hemoglobins
Hemodynamics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{4895402e79764fb9943e75c4b5b0e49e,
title = "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",
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.",
author = "Lee, {Jeong Soo} and Ahn, {So Woon} and Song, {Jong Wook} and Shim, {Jae Kwang} and Yoo, {Kyung Jong} and Younglan Kwak",
year = "2011",
month = "10",
day = "1",
doi = "10.1253/circj.CJ-11-0404",
language = "English",
volume = "75",
pages = "2397--2402",
journal = "Circulation Journal",
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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. / Lee, Jeong Soo; Ahn, So Woon; Song, Jong Wook; Shim, Jae Kwang; Yoo, Kyung Jong; Kwak, Younglan.

In: Circulation Journal, Vol. 75, No. 10, 01.10.2011, p. 2397-2402.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 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

AU - Lee, Jeong Soo

AU - Ahn, So Woon

AU - Song, Jong Wook

AU - Shim, Jae Kwang

AU - Yoo, Kyung Jong

AU - Kwak, Younglan

PY - 2011/10/1

Y1 - 2011/10/1

N2 - 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.

AB - 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.

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U2 - 10.1253/circj.CJ-11-0404

DO - 10.1253/circj.CJ-11-0404

M3 - Article

VL - 75

SP - 2397

EP - 2402

JO - Circulation Journal

JF - Circulation Journal

SN - 1346-9843

IS - 10

ER -