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.	钱厚明, 黄成垠, 徐士云, 等.血小板凝血活性对预防性血小板输注的预示价值研究.临床检验杂志, 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术治疗六例.中国胸心血管外科临床杂志, 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, 戴锦杰, 韩文正, 等.血栓弹力图与活化凝血时间评价PCI术中普通肝素效果的比较研究.上海交通大学学报:医学版, 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.	赵莹, 胡森译.早期创伤诱导凝血可能与血液稀释和体液中凝血因子减少有关.中国危重病急救医学, 2011, 23(6):358-358.
12.	杨丽君, 林茹, 叶莉芬, 等.血栓弹力图在小儿体外循环围术期的应用价值.中国体外循环杂志, 2013, 11(1):11-14.
13.	齐洛生, 杨宏富, 孙荣青, 等.严重外伤患者的凝血功能变化.中国危重病急救医学, 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.	张雪姣, 唐安丽, 廖新学, 等.可溶性血栓调节蛋白与冠心病患者短期预后的关系.中山大学学报:医学科学版, 2006, 23(z1):135-137.
20.	杨海娜, 王伟, 卢绍禹, 等.血栓弹力图(TEG)在冠心病凝血监测中的临床应用.实用心脑肺血管病杂志, 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.	管玉龙, 龙村.粘弹性凝血功能监测技术的应用及进展.中国胸心血管外科临床杂志, 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. 钱厚明, 黄成垠, 徐士云, 等.血小板凝血活性对预防性血小板输注的预示价值研究.临床检验杂志, 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术治疗六例.中国胸心血管外科临床杂志, 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, 戴锦杰, 韩文正, 等.血栓弹力图与活化凝血时间评价PCI术中普通肝素效果的比较研究.上海交通大学学报:医学版, 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. 赵莹, 胡森译.早期创伤诱导凝血可能与血液稀释和体液中凝血因子减少有关.中国危重病急救医学, 2011, 23(6):358-358.
12. 杨丽君, 林茹, 叶莉芬, 等.血栓弹力图在小儿体外循环围术期的应用价值.中国体外循环杂志, 2013, 11(1):11-14.
13. 齐洛生, 杨宏富, 孙荣青, 等.严重外伤患者的凝血功能变化.中国危重病急救医学, 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. 张雪姣, 唐安丽, 廖新学, 等.可溶性血栓调节蛋白与冠心病患者短期预后的关系.中山大学学报:医学科学版, 2006, 23(z1):135-137.
20. 杨海娜, 王伟, 卢绍禹, 等.血栓弹力图(TEG)在冠心病凝血监测中的临床应用.实用心脑肺血管病杂志, 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. 管玉龙, 龙村.粘弹性凝血功能监测技术的应用及进展.中国胸心血管外科临床杂志, 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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