Emin KAYA, Akgül Feray ERDİL, Hüseyin Toprak İLKSEN, Ahmet KÖROĞLU, Nevzat ERDİL, Bektaş BATTALOĞLU, Vedat NİSANOĞLU

Koroner arter bypass cerrahisinde akut normovolemik hemodilüsyonun koagülasyon, fibrinolitik sistem, protein C ve protein S üzerine etkisi

Amaç: Kardiyopulmoner bypass (KPB) kullanılarak yapılan kalp cerrahisi, hemostatik sistemde çeşitli değişikliklere yol açar. Bu çalışmada 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 l, n = 20) ve uygulanmayarak (Grup 2, n = 21) koroner arter cerrahisi yapılan 41 hasta çalışmaya alındı. Aktive edilmiş pıhtılaşma zamanı, protrombin zamanı, aktif parsiyel tromboplastin zamanı, fibrin yıkım ürünleri (d-dimer), fibrinojen, protein C ve S ile trombosit sayıları ölçüldü. Kan örnekleri anestezi indüksiyonunu takiben KPB'nin 20. dakikası, protamin uygulamasından 30 dakika sonrası ve KPB'den çıkıldıktan 24 saat sonra alındı. Bulgular: Her iki grupta preoperative değerlerle kıyaslandığında diğer örneklerde d-dimer değerleri yüksek, protein C ve trombosit sayıları anlamlı derecede düşük bulundu. Gruplar arasında aktive pıhtılaşma zamanı, protrombin ve aktif parsiyel tromboplastin zamanları, d-dimer, fibrinojen, protein C ve protein S değerleri açısından farklılık tespit edilmedi. İki grup arasında kan ve kan ürünleri transfüzyonu ve drenaj miktarı açısından fark bulunmadı. Sonuç: Koroner arter cerrahisinde akut normovolemik hemodilüsyon kan ve kan ürünleri ihtiyacını azaltmamakta ve hemostatik sistemdeki değişiklikleri etkilememektedir.

The effect of acute normovolemic hemodilution on coagulation, fibrinolytic system, protein C and protein S in coronary artery bypass surgery

Background: Cardiac surgery performing with cardiopulmonary bypass (CPB) causes multiple alterations in the hemostatic system. In this study, we investigated the effect of acute normovolemic hemodilution on coagulation, fibrinolytic system and physiologic . anticoagulants such as protein C and S among patients who underwent coronary artery bypass grafting (CABG). Methods: Forty one patients who underwent CABG with (Group l, n = 20) and without (Group 2, n = 21) acute normovolemic hemodilution were enrolled in this study. Activated clotting time (ACT), prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer (fibrin degradation product), fibrinogen, protein C and S, and platelet count were measured. Blood samples were collected after induction of anesthesia, 20 minutes after the beginning of CPB, 30 minutes after administration of protamine, and 24 hours after the weaning from CPB. Transfused blood products and mediastinal bleeding were recorded. Results: Within both groups, D-dimer elevated, and protein C values and platelet count decreased significantly at all samples compared with preoperative values. The changes of ACT, PT, aPTT, D-dimer, fibrinogen, protein C and S and platelet count were similar in both groups. There were no statistically significant differences between both groups with respect to the blood transfusion and mediastinal bleeding. Conclusions: Acute normovolemic hemodilution in CABG surgery does not significantly decrease blood products requirements and. the changes in hemostatic system are not effected by this technique

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