Comparison of acute normovolemic hemodilution effect on the amount of bleeding in the first 48 hours after coronary artery bypass grafting
Keywords:Acute normovolemic hemodilution, Bleeding, Coronary artery bypass grafting
Background: Cardiovascular disease is one of the most common causes of mortality in developed countries, as well as in the whole world. In this regard, autologous transfusion is a topic that can be useful and valuable, especially in complex surgery such as heart surgery and organ transplantation. One of its variants is Acute Normovolomic Hemodilution (ANH). Therefore, the aim of this study was to compare the effect of ANH on the amount of bleeding in the first 48hours after coronary artery bypass grafting.
Methods: In this clinical trial, 100 patients were selected from all heart patients referred to Imam Khomeini Hospital in Ardebil for CABG surgery in the years 2016-17. They were selected by simple random sampling as a statistical sample and They were divided into intervention (50 ANH recipients’ people) and control groups (50 without ANH people).
Results: Based on the findings, in the ANH recipients’ group, the mean of bleeding volume was 59.1±7.3ml in the first day and 55.6±4.2ml in the control group and the difference between the two groups was not significant on the first day. The mean of bleeding volume on the second day was 46.1±2.8ml in the ANH group and 42.7±2.9ml in the control group. Although it was somewhat higher, it was not statistically significant. Of all samples 45% were female and 55% were male. The most common type of blood group was 33 (33%) in the blood group O. The highest age group (61%) was over the 60 years old. The pump time varied with an average of 122.2±21.5minutes. The lowest value was PT 11 and the highest was 15 with an average of 13.02±0.9seconds. The mean of PTT was 32.5±2.6seconds and the mean INR was 1.1±1.0. The average plt was 251170±64124. The mean ACT was 596 / 6±183/7seconds.
Conclusions: The results showed that in the mean of bleeding volume between the intervention and control groups (p = 0.41), bleeding volume by age (p = 0.3), bleeding volume by gender (p =0.54) and bleeding volume by blood group (p=0.48) was not significant difference. Based on these results, it is suggested that more studies be done on the more number of samples.
Marray CJL, Lopez AD. Global burden of disease (Summary). WHO 1997;21:576-60. Available at: http://apps.who.int/iris/bitstream/handle/10665/41864/0965546608_eng.pdf;jsessionid=2A51E7FCFC3BA7B609D639FFCDF982E4?sequence=1.
Braunwald E, Fauci A, Kasper D, Hauser S. Harrison’s Principles of Internal Medicine, Mc Graw Hill: USA 2008; 20:1377-80.
Braunwald E, Fauci A, Kasper D, Hauser S. Harrison’s Principles of Internal Medicine., Mc Graw Hill: USA; 2008;20:1399-410.
Abramov D, Tamariz MG, Sever JY, Christakis GT, Bhatnagar G, Heenan AL, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thoracic Surg. 2000 Sep 1;70(3):800-5.
Hussain KM, Kogan A, Estrada AQ, Kostandy G, Foschi A. Referral pattern and outcome in men and women undergoing coronary artery bypass surgery: a critical review. Angiol. 1998 Apr;49(4):243-50.
Sutton RG, Kratz JM, Spinale FG, Crawford FA. Comparison of three blood-processing techniques during and after cardiopulmonary bypass. Ann Thoracic Surg. 1993 Oct 1;56(4):938-43.
Christakis GT, Weisel RD, Buth KJ, Fremes SE, Rao V, Panagiotopoulos KP, et al. Is body size the cause for poor outcomes of coronary artery bypass operations in women?. J Thoracic Cardiovascular Surg. 1995 Nov 1;110(5):1344-58.
Craddock D, Iyer VS, Russell WJ. Factors influencing mortality and myocardial infarction after coronary artery bypass grafting. Current Opinion Cardiol. 1994 Nov;9(6):664-9.
O'Connor GT, Plume SK, Olmstead EM, Coffin LH, Morton JR, Maloney CT, et al. A regional prospective study of in-hospital mortality associated with coronary artery bypass grafting. JAMA. 1991 Aug 14;266(6):803-9.
Bennett J, Haynes S, Torella F, Grainger H, McCollum C. Acute normovolemic hemodilution in moderate blood loss surgery: a randomized controlled trial. Transfusion. 2006 Jul;46(7):1097-103.
Robinson ST. Intraoperative moderate Acute Normovolemic Hemodilution associated with a comprehensive blood-sparing protocol in off-pump coronary surgery. Survey Anesthesiol. 2005 Apr 1;49(2):55-6.
Dahaba AA, Rinnhofer S, Wang G, Xu X, Liu XY, Wu XM, et al. Influence of acute normovolaemic haemodilution on bispectral index monitoring and propofol dose requirements. Acta Anaesthesiol Scand. 2008 Jul;52(6):815-20.
Karlsson M, Ternström L, Hyllner M, Baghaei F, Nilsson S, Jeppsson A. Plasma fibrinogen level, bleeding, and transfusion after on‐pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion. 2008 Oct;48(10):2152-8.
Mehran R, Pocock SJ, Nikolsky E, Clayton T, Dangas GD, Kirtane AJ, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010 Jun 8;55(23):2556-66.
Momeni M, Van Dyck M, Aranda F, Watremez C. Acute normovolemic hemodilution during CABG induces diastolic dysfunction: a perioperative transesophageal echocardiography study: 4AP6-3. European J Anaesthesiology. 2011 Jun 1;28:54.
Murray D. Acute normovolemic hemodilution. Haemostasis Spine Surg. 2005;13:72-5.
Nouraei M, Baradari AG, Ghafari R, Habibi MR, Zeydi AE, Sharifi N. Decreasing blood loss and the need for transfusion after CABG surgery: a double-blind randomized clinical trial of topical tranexamic acid. Turkish J Med Sci. 2013 Apr 2;43(2):273-8.
Shander A. Acute Normovolemic Hemodilution (ANH): a practical approach. Transfusion Alternatives Transfusion Med. 1999 Dec;1(4):7-10.
Stone GW, Clayton TC, Mehran R, Dangas G, Parise H, Fahy M, et al. Impact of major bleeding and blood transfusions after cardiac surgery: analysis from the acute catheterization and urgent intervention triage strategy (ACUITY) trial. Am Heart J. 2012 Mar 1;163(3):522-9.
Naddafniya H, Ferasat R, Alavi M, Naseri M, GHodsi M, Mohaghegh M. The effect of the technique (ANH) Acute Normovolemic Hemodilution on hemostasis of patients using thromboelastography in patients with coronary artery bypass grafting by cardiopulmonary bypass. J Health Sci Res. 2008;6(1):70-65.
Mahoori A, Heshmati F, Noroozinia H, Mehdizadeh H, Salehi S, Rohani M. Intraoperative minimal acute normovolemic hemodilution in patients undergoing coronary artery bypass surgery. Middle East J Anesthesiol. 2009;20(3):423-30.
Or TH, Yang MW, Fan WL, Chan KH, Lee TY. Acute normovolemic hemodilution in coronary artery bypass graft surgery. Anaesthesiol Sinica. 1991 Jun;29(2):586-91.
Casati V, Speziali G, D'alessandro C, Cianchi C, Grasso MA, Spagnolo S, et al. Intraoperative low-volume acute normovolemic hemodilution in adult open-heart surgery. Anesthesiology. 2002 Aug 1;97(2):367-73.
Helm RE, Klemperer JD, Rosengart TK, Gold JP, Peterson P, DeBois W, Altorki NK, Lang S, Thomas S, Isom OW, Krieger KH. Intraoperative autologous blood donation preserves red cell mass but does not decrease postoperative bleeding. Ann Thoracic Surg. 1996 Nov 1;62(5):1431-41.
Virmani S, Tempe DK, Pandey BC, Cheema AS, Datt V, Garg M, et al. Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery. Ann Cardiac Anaesthesia. 2010 Jan 1;13(1):34.