title: Intraoperative moderate acute normovolemic hemodilution associated with a comprehensive blood-sparing protocol in off-pump coronary surgery.
abstract: We evaluated the blood-sparing effects of intraoperative moderate acute normovolemic hemodilution (ANH) combined with intraoperative tranexamic acid treatment and shed blood reinfusion in patients undergoing off-pump coronary artery bypass (OPCAB). One-hundred consecutive OPCAB patients (baseline hematocrit >34%) were prospectively randomized to tranexamic acid treatment (control group; 50 patients) or to tranexamic acid treatment plus normovolemic (1:1 replacement with colloids) withdrawal of 17% +/- 2% of the circulating blood volume (ANH group; 50 patients). All patients had shed blood reinfused with intraoperative bleeding in excess of 250 mL. The requirement for allogeneic transfusions, based on strict a priori defined criteria, was the primary end point of the study. Hematochemical evaluations, bleeding, major complications, and other outcomes were also recorded. Demographics, baseline hematochemical data, and operative characteristics were similar in the two groups. Patients in the ANH group had a median of 850 mL of blood withdrawn and showed a lower intraoperative minimum hematocrit (31% vs 37%; P < 0.0001). Two patients in the ANH group versus 10 patients in the control group (odds ratio, 0.17; 95% confidence interval, 0.03-0.89; P = 0.028) required transfusion of a significantly smaller number of packed red blood cell units (5 vs 24; P < 0.001). Postoperative hematochemical variables, bleeding, and outcomes were similar in the two groups of patients. Moderate ANH, combined with tranexamic acid administration and on-demand shed blood reinfusion, may reduce allogeneic transfusion requirements in OPCAB patients.
  
  
  CONCLUSIONS
  We studied the blood-sparing effects of moderate acute normovolemic hemodilution (ANH) in 100 patients undergoing off-pump coronary surgery (OPCAB). Combined with tranexamic acid administration and shed blood reinfusion when the intraoperative bleeding exceeded 250 mL, ANH was effective in reducing the number of OPCAB patients who required allogeneic transfusions and the number of packed red blood cell units transfused.
authors.affiliation: Division of Cardiovascular Anesthesia and Intensive Care, Policlinico di Monza, Monza, Italy. valter.casati@policlinicodimonza.it.
authors.forename: Valter
authors.initials: V
authors.lastname: Casati
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Luca
authors.initials: L
authors.lastname: Sandrelli
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Grasso
authors.forename: Salvatore
authors.initials: S
authors.lastname: Spagnolo
authors.forename: Armando
authors.initials: A
authors.lastname: D'Angelo
mesh_terms: D000368:Aged; D000758:Anesthesia; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001772:Blood Cell Count; D001803:Blood Transfusion; D001810:Blood Volume / Q000502:physiology; D006348:Cardiac Surgical Procedures; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006400:Hematocrit; D006438:Hemodilution; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000503:physiopathology; D011446:Prospective Studies; D014148:Tranexamic Acid / Q000627:therapeutic use
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid