EFFECT OF ACUTE NORMOVOLEMIC HEMODILUTION ON COAGULATION , FIBRINOLYTIC SYSTEM , PROTEIN C AND S IN CORONARY ARTERY BYPASS SURGERY

Amaç: Kardiyopulmoner bypass (KPB) kullanýlarak yapýlan kalp cerrahisi, hemostatik sistemde çeþitli deðiþikliklere yol açar. Bu çalýþmada koroner arter cerrahisi uygulanan hastalarda akut normovolemik hemodilüsyonun koagülasyon, fibrinolitik sistem ve protein S ve C gibi fizyolojik antikoagülanlar üzerine etkisini inceledik. Materyal ve Metod: Akut normovolemik hemodilüsyon uygulanarak (Grup 1, n = 20) ve uygulanmayarak (Grup 2, n = 21) koroner arter cerrahisi yapýlan 41 hasta çalýþmaya alýndý. Aktive edilmiþ pýhtýlaþma zamaný, protrombin zamaný, aktif parsiyel tromboplastin zamaný, fibrin yýkým ürünleri (d-dimer), fibrinojen, protein C ve S ile trombosit sayýlarý ölçüldü. Kan örnekleri anestezi indüksiyonunu takiben KPB’nin 20. dakikasý, protamin uygulamasýndan 30 dakika sonrasý ve KPB’den çýkýldýktan 24 saat sonra alýndý. Bulgular: Her iki grupta preoperative deðerlerle kýyaslandýðýnda diðer örneklerde d-dimer deðerleri yüksek, protein C ve trombosit sayýlarý anlamlý derecede düþük bulundu. Gruplar arasýnda aktive pýhtýlaþma zamaný, protrombin ve aktif parsiyel tromboplastin zamanlarý, d-dimer, fibrinojen, protein C ve protein S deðerleri açýsýndan farklýlýk tespit edilmedi. Ýki grup arasýnda kan ve kan ürünleri transfüzyonu ve drenaj miktarý açýsýndan fark bulunmadý. Sonuç: Koroner arter cerrahisinde akut normovolemik hemodilüsyon kan ve kan ürünleri ihtiyacýný azaltmamakta ve hemostatik sistemdeki deðiþiklikleri etkilememektedir.

[1]  M. Felfernig,et al.  The effects of hydroxyethyl starch solutions on thromboelastography in preoperative male patients , 2003 .

[2]  G. Speziali,et al.  Intraoperative Low-volume Acute Normovolemic Hemodilution in Adult Open-heart Surgery , 2002, Anesthesiology.

[3]  M. Ray,et al.  Comparison of epsilon aminocaproic acid and low-dose aprotinin in cardiopulmonary bypass: efficiency, safety and cost. , 2001, The Annals of thoracic surgery.

[4]  J. Boldt,et al.  Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery. , 2000, British journal of anaesthesia.

[5]  K. Kario,et al.  Fibrin D-dimer in thrombogenic disorders. , 2000, Seminars in thrombosis and hemostasis.

[6]  C. Whitten,et al.  D-Dimer formation during cardiac and noncardiac thoracic surgery. , 1999, Anesthesia and analgesia.

[7]  I. Paşaoǧlu,et al.  The effect of acute normovolemic hemodilution on homologous blood requirements and total estimated red blood cell volume lost , 1997, Acta anaesthesiologica Scandinavica.

[8]  E. Spitznagel,et al.  More Effective Suppression of Hemostatic System Activation in Patients Undergoing Cardiac Surgery by Heparin Dosing Based on Heparin Blood Concentrations rather than ACT , 1996, Thrombosis and Haemostasis.

[9]  M. Siimes,et al.  Fibrinolysis, antithrombin III, and protein C in neonates during cardiac operations. , 1996, The Journal of thoracic and cardiovascular surgery.

[10]  J. M. Carr,et al.  Significance of D-dimer concentrations during and after cardiopulmonary bypass. , 1996, Journal of cardiothoracic and vascular anesthesia.

[11]  P. Mortensen,et al.  Autotransfusion after coronary artery bypass grafting halves the number of patients needing blood transfusion. , 1996, The Annals of thoracic surgery.

[12]  C. Sintek,et al.  Intraoperative autotransfusion reduces blood loss after cardiopulmonary bypass. , 1996, The Annals of thoracic surgery.

[13]  K. Hashimoto,et al.  Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation. , 1994, The Annals of thoracic surgery.

[14]  C. Greenberg,et al.  Characterization of Prothrombin Activation during Cardiac Surgery by Hemostatic Molecular Markers , 1994, Anesthesiology.

[15]  W. Williams,et al.  Thrombin regulation in congenital heart disease after cardiopulmonary bypass operations. , 1994, The Journal of thoracic and cardiovascular surgery.

[16]  U. Prakanrattana,et al.  Acute hemodilution and autotransfusion in cardiac surgery: a comparison between rather healthy and high risk patients. , 1993, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[17]  B. Pasche,et al.  The platelet function defect of cardiopulmonary bypass. , 1993, Blood.

[18]  A. Siddiqui,et al.  Blood Conservation and Autotransfusion in Cardiac Surgery , 1993, Journal of cardiac surgery.

[19]  S. Nicolson,et al.  Coagulation defects in neonates during cardiopulmonary bypass. , 1993, The Annals of thoracic surgery.

[20]  R. Hillman,et al.  Platelet activation and aggregation during cardiopulmonary bypass. , 1991, Anesthesiology.

[21]  J. Paramo,et al.  Intra- and postoperative fibrinolysis in patients undergoing cardiopulmonary bypass surgery. , 1991, Haemostasis.

[22]  L. Harker,et al.  Bleeding complications associated with cardiopulmonary bypass. , 1990, Blood.

[23]  T. Inglis,et al.  Postoperative autologous transfusion in cardiac surgery. A prospective, randomised study. , 1990, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[24]  R. Wilson,et al.  Hemostasis Changes During Cardiopulmonary Bypass Surgery , 1985, Seminars in thrombosis and hemostasis.

[25]  A. Imbriano.  [Blood coagulation]. , 1955, La Semana medica.