Disorders of the hemostasis system while doing coronary shunting on a working heart

A. P.  Mazur; P. V.  Gurin; M. M.  Babich

doi:10.26779/2522-1396.2019.07.23

A. P. Mazur Shalimov National Institute of Surgery and Transplantology, Kyiv http://orcid.org/0000-0002-6873-7573
P. V. Gurin Shalimov National Institute of Surgery and Transplantology, Kyiv http://orcid.org/0000-0002-2234-1258
M. M. Babich Shalimov National Institute of Surgery and Transplantology, Kyiv http://orcid.org/0000-0002-5122-5301

DOI: https://doi.org/10.26779/2522-1396.2019.07.23

Keywords: coagulation hemostasis; colloidal solutions; blood loss; hemotransfusion.

Abstract

Objective. To investigate the connection between application of solutions for infusion and parameters of the hemostasis system while the elective operations performance of coronary shunting on the working heart.

Materials and methods. The results of examination and surgical treatment were analyzed in 80 patients, in whom coronary shunting on the working heart was conducted. The patients were divided into three groups: the Investigation Group I (IG I) – 20 patients, in whom colloidal solution of hydroxyethyl starch (HES) 130/0.4 was applied intraoperatively, the Investigation Group II (IG II) - 20 patients, in whom colloidal 4% solution of gelatin was used intraoperatively, and a Control Group, consisted of 40 patients, in whom only crystalloidal solutions were included in the infusion therapy program. The coagulation hemostasis indices, the blood loss volume and the need for hemotransfusion were compared.

Results. In the IG I patients the volume of perioperative blood loss was more than in the IG II patients – (615 ± 191) and (438 ± 62) ml, accordingly (p=0.0003), and the coagulation hemostasis indices were trustworthily lower at the operation ending, demanding the erythrocytic mass transfusion doing in 3 (15%) patients. The IG II patients, comparing with the Control Group, suffered more volume of the blood loss - (560 ± 164) and (438 ± 62) ml, accordingly (p=0,02), and the changes in the coagulation indices, similar to changes in patients of the IG I, comparing with the Control Group patients. Any patient from the IG II needed hemotransfusion perioperatively.

Conclusion. Application of colloidal solutions while doing elective operations of CSH on the working heart leads to disorder of coagulation hemostasis, the intraoperative blood loss and the need for hemotransfusion enhancement.

Author Biographies

A. P. Mazur, Shalimov National Institute of Surgery and Transplantology, Kyiv

Mazur Andriy P. –MD, DSci (Med), Professor.
Head of thedepartment of anesthesiologyandintensivecare,
O. O. Shalimov National institute of surgery and transplantology,
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine
+38 044 408 23 11
paracelsus@ukr.net
orcid.org/0000-0002-6873-7573

P. V. Gurin, Shalimov National Institute of Surgery and Transplantology, Kyiv

Gurin Pavlo - anesthesiologist of the department of general and transplantation anesthesiology,
O. O. Shalimov National Institute of Surgery and Transplantology,
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine
+38 044-408-18-66
p_gurin@i.ua
orcid.org/0000-0002-2234-1258

M. M. Babich, Shalimov National Institute of Surgery and Transplantology, Kyiv

Babich Maksim - anesthesiologist
department of general and transplantation anesthesiology,
O. O. Shalimov National institute of surgery and transplantology,
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraine
+380 44-408-18-66
supermax@ukr.net
orcid.org/0000-0002-5122-5301

References

YanalaUR, Johanning JM, Pipinos II, High RR, Larsen G, Velander WH, et al. Fluid administration rate for uncontrolled intraabdominal hemorrhage in swine. PLoS One. 2018;13(11):e0207708. doi: 10.1371/journal.pone.0207708.

Rasmussen K, Johansson P, Hoejskov M, Kridina I, Kistorp T, Thind P, et al. Hydroxyethyl starch reduces coagulation competence and increase blood loss during major surgery. Results from a randomized controlled trial. Ann Surg. 2014;2:249–54. doi:10.1097/SLA.0000000000000267.

Hung MH, Zou C, Lin FS, Lin CJ, Chan KC, Chen Y. New 6% hydroxyethyl starch 130/0.4 does not increase blood loss during major abdominal surgery – a randomized, controlled trial. J Formos Med Assoc. 2014;113:429–35. doi:10.1016/j.jfma.2012.08.002.

Krzych ŁJ, Czempik PF. Hooves better than potatoes: in vitro effects of balanced crystalloid and colloids on functional parameters of coagulation and fibrinolysis. Pol Arch Intern Med. 2017;127(3):209-11. doi: 10.20452/pamw.3981.

Fenger-Eriksen C. Acquired fibrinogen deficiency caused by artificial colloid plasma expanders. Wien Klin Wochenschr. 2010;122(Suppl 5):S21–2. PMID: 215984444.

Fenger-Eriksen C, Moore GW, Rangarajan S, Ingerslev J, Sorensen B. Fibrinogen estimates are influenced by methods of measurement and hemodilution with colloid plasma expanders. Transfusion. 2010;50(12):2571–6. doi: 10.1111/j.1537-2995.2010.02752.x.

Chang R, Holcomb JB. Optimal fluid therapy for traumatic hemorrhagic shock. Crit Care Clin. 2017;33(1):15–36. doi: 10.1016/j.ccc.2016.08.007.

Zangrillo A, Gerli C, Landoni G, Sparicio D, Roberti A, Sottocorna O, et al. Anesthesiological management and outcome of 100 ''beating heart'' coronary artery bypass grafting. MinervaAnestesiol. 2006;72(10):827-39. PMID: 17006420.

Van Der Linden P, James M, Mythen M, Weiskopf RB. Safety of modern starches used during surgery. Anesth Analg, 2013;116(1):35-48. doi: 10.1213/ANE.0b013e31827175da.

Patel A, Waheed U, Brett S J. Randomised trials of 6% tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis. Int Care Med. 2013;39:811–22. doi: 10.1007/s00134-013-2863-6.

Gattas DJ, Dan A, Myburgh J, Billot L, Lo S, Finfer S. CHEST Management Committee. Fluid resuscitation with 6% hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy. Intensive Care Med. 2013;39:558–68. doi: 10.1007/s00134-013-2840-0.

Güneş I, Süngü N, Kılıçarslan A, Şıvgın V, Alkan M, KüçükA, et al. Effects of hydroxyethyl starch 130/0.4 on the kidney tissue of rats with ureteral obstruction. Drug Des DevelTher. 2018;12:3061-70. doi: 10.2147/DDDT.S165695.

Rasmussen K, Secher N, Pedersen T. Effect of perioperative colloid and crystalloid fluid therapy on coagulation competence, haemorrhage and outcome: A systematic review and stratified meta-analysis. Medicine (Baltimore). 2016;95(31):1-10. doi: 10.1097/MD.0000000000004498.

Hung M, Zou C, Lin F, Lin C, Chan K, Chen Y. New 6% hydroxyethyl starch 130/0.4 does not increase blood loss during major abdominal surgery – a randomized, controlled trial. J Formos Med Assoc. 2014;113:429–35. doi: 10.1016/j.jfma.2012.08.002.