Celite-activated viscometer Sonoclot can measure the suppressive effect of tranexamic acid on hyperfibrinolysis in cardiac surgery

被引：16

作者：

Kamada K. ^{[1
]}

Yamakage M. ^{[1
]}

Niiya T. ^{[1
]}

Tsujiguchi N. ^{[1
]}

Chen X. ^{[1
]}

Namiki A. ^{[1
]}

机构：

[1] Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Hokkaido 060-8543

来源：

Journal of Anesthesia | 2001年 / 15卷 / 1期

关键词：

Cardiac surgery; Celite; Fibrinolysis; Tranexamic acid; Viscometer;

D O I：

10.1007/s005400170046

中图分类号：

学科分类号：

摘要：

Purpose. To investigate the usefulness of the celite-activated viscometer Sonoclot for monitoring fibrinolytic status in cardiac surgery, we demonstrated the demonstrated effectiveness of high doses of tranexamic acid, an antifibrinolytic agent, in reducing post-operative bleeding. Methods. Thirty-two American Society of Anesthesiologists (ASA) physical status III patients who required cardiac surgery with cardiopulmonary bypass (CPB) were studied. Anesthesia was induced by a high dose of fentanyl and midazolam with oxygen and was maintained by the intermittent administration of these agents. Patients were divided into two groups: the control group (n = 15) and patients receiving tranexamic acid (TA; n = 17). The TA group received a high dose (50 mg/kg) of TA twice, once before and once after CPB. The percentage diminishing rate of the Sonoclot tracing 15 min after maximum clot signal (DR15) and the amount of postoperative bleeding were measured. Results. After CPB, DR15 in the control group (mean 28.3%) increased significantly by 45%, and the DR15 in the TA group (16.1%) was significantly lower than that in the control group. The amount of postoperative bleeding in the TA group (546 ml) was significantly less, by 34%, than that in the control group (829 ml). Conclusion. Prophylactic administration of high-dose TA in cardiac surgery reduces postoperative bleeding, and this effect is consistent with changes in the diminishing rate using Sonoclot. The celite-activated viscometer Sonoclot is recommended for use in cardiac surgery for rapid assessment of fibrinolytic status.

引用

页码：17 / 21

页数：4

共 22 条

[1]

Rinder C.S., Bohnert J., Rinder H.M., Mitchell J., Ault K., Hillman R., Platelet activation and aggregation during cardiopulmonary bypass, Anesthesiology, 75, pp. 388-393, (1991)

[2]

Bick R.L., Hemostasis defects associated with cardiac surgery, prosthetic devices, and other extracorporeal circuits, Semin Thromb Hemost, 11, pp. 249-280, (1985)

[3]

Surgenor D.M., Churchill W.H., Wallace E.L., Rizzo R.J., Chapman R.H., McGurk S., Bertholf M.F., Goodnough L.T., Kao K.J., Koerner T.A., Olson J.D., Woodson R.D., Determinations of red cell, platelet, plasma, and cryoprecipitate transfusions during coronary artery bypass graft surgery: The collaborative hospital transfusion study, Transfusion, 36, pp. 521-532, (1996)

[4]

Tuman K.J., Spiess B.D., McCarthy R.J., Ivankovich A.D., Comparison of viscoelastic measures of coagulation after cardiopulmonary bypass, Anesth Analg, 69, pp. 69-75, (1989)

[5]

Marengo-Rowe A.J., Leveson J.E., Fibrinolysis: A frequent cause of bleeding, pp. 41-55, (1988)

[6]

Essell J.H., Martin T.J., Sallinas J., Thompson J.M., Smith V.C., Comparison of thromboelastography to bleeding time and standard coagulation tests in patients after cardiopulmonary bypass, J Cardiothorac Vasc Anesth, 7, pp. 410-415, (1993)

[7]

Spiess B.D., Tuman K.J., McCarthy R.J., DeLaria G.A., Schillo R., Ivankovich A.D., Thromboelastography as an indicator of post-cardiopulmonary bypass coagulopathies, J Clin Monit, 3, pp. 25-30, (1987)

[8]

Niiya T., Yamakage M., Kamada Y., Namiki A., Evaluation of blood fibrinolysis by the use of a celite-activated thromboelastography (Sonoclot), J Clin Anesth, 23, pp. 1123-1126, (1999)

[9]

Karski J.M., Teasdale S.J., Norman P., Carroll J., VanKessel K., Wong P., Glynn M.F., Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid. Double-blind, randomized clinical traial, J Thorac Cardiovasc Surg, 110, pp. 835-842, (1995)

[10]

Hardy J.F., Belisle S., Dupont C., Harel F., Robitaille D., Roy M., Gagnon L., Prophylactic tranexamic acid and epsilon-aminocaproic acid for primary myocardial revascularization, Ann Thorac Surg, 65, pp. 371-376, (1998)

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