Desmopresin ve traneksamik asitin acil izole koroner arter bypass greftleme (KABG) ameliyatında kan ürünü kullanımına ve postoperatif kanama üzerine etkisi

Yıl 2020, Cilt: 11 Sayı: 3, 93 - 99, 22.06.2020

Naim Boran Tümer , Atike Tekeli Kunt , Serdar Günaydın , Kanat Özışık , Eren Günertem , Ali Baran Budak , Seyhan Babaroğlu , Onur Karahasanoğlu

https://doi.org/10.18663/tjcl.733844

Öz

Amaç: Kanama kalp cerrahisinde önemli bir sorundur ve artan morbidite ve mortalite ile ilişkili yüksek allojenik kan transfüzyonu riskine yol açar. Son yıllarda, literatürdeki çalışmalar desmopresinin (1-deamino-8-D-arginin vazopressin, DDAVP) cerrahi müdahalelerden sonra kan kaybını azalttığını bildirmişlerdir. Bu çalışmanın amacı, kardiyologlar tarafından P2Y12 inhibitörleri ile tedavi edilen ve acil koroner arter baypas greftleme (KABG) ameliyatı geçiren hastalarda desmopressin ve traneksamik asidin kan ürünü kullanımı ve postoperatif kanama üzerindeki etkisini analiz etmektir.
Gereç ve Yöntemler: Acil izole KABG ameliyatı geçiren ve öncesinde P2Y12 inhibitörleri ile tedavi edilmiş 62 erişkin hastanın prospektif olarak toplanan verileri retrospektif olarak incelendi. Hastaların perioperatif verileri birlikte demografik verileri, laboratuvar bulguları, göğüs tüplerinden kan kaybı miktarı, kan ürünü kullanım miktarı, yeniden torakotomi ihtiyacı, morbidite ve mortalite sonuçları değerlendirildi. Hasta popülasyonu iki gruba ayrıldı: Grup I: Perioperatif traneksamik asit ve DDAVP alan hastalar (n=26); ve Grup II: Perioperatif olarak sadece traneksamik asit alan hastalar (n=36).
Bulgular: İki hasta grubu başlangıçta benzer özelliklere sahipti. Grup I ve II arasında göğüs tüplerinden postoperatif kan kaybı, yeniden torakotomi, alyuvar ve trombosit transfüzyonları açısından istatistiksel olarak anlamlı fark vardı (p <0.05). İki grup arasında taze donmuş plazma transfüzyonu, inotropik destek ve mortalite açısından istatistiksel olarak anlamlı bir fark gözlenmemiştir.
Sonuç: Acil izole KABG ameliyatı geçirenlerde traneksamik asitle birlikte desmopresin kullanımının perioperatif/ postoperatif kanamayı ve kan ürünü kullanımını azalttığını düşünüyoruz. 

Anahtar Kelimeler

Desmopresin, Traneksamik Asit, Kan yönetimi, KABG

The effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding after emergent isolated coronary artery bypass grafting (CABG) surgery

Öz

Aim: Bleeding is a major problem in cardiac surgery, and results in a high risk of allogeneic blood transfusion associated with increased morbidity and mortality. In recent years, studies in the literature reported that desmopressin (1-deamino-8-D-arginine vasopressin, DDAVP) reduces the blood loss after surgical interventions. The aim of the present study is to analyze the effect of desmopressin and tranexamic acid on blood product use and postoperative bleeding in patients that were pretreated with P2Y12 inhibitors by cardiologists and undergone emergent coronary artery bypass grafting (CABG) surgery.
Material and Methods:The prospectively collected data of 62 adult patients who underwent emergent isolated CABG surgery and pretreated with P2Y12 inhibitors by cardiologists were retrospectively reviewed. The perioperative data of the patients included their demographic data, laboratory findings, the amount of blood loss from chest tubes, the amount of blood product use, need of re-thoracotomy, morbidity and mortality. The patient population was divided into two groups: Group I: Patients that received tranexamic acid and DDAVP perioperatively (n=26); and Group II: Patients that received only tranexamic acid perioperatively (n=36).
Results: The two groups of patients had similar characteristics at baseline. There was a statistically significant difference between Group I and II regarding postoperative blood loss from the chest tubes, re-thoracotomy, red blood cell and thrombocyte transfusions (p<0.05). No statistically significant differences were observed between the two groups in terms of fresh frozen plasma transfusion, inotropic support and mortality.
Conclusion: We suggest that desmopressin in addition to tranexamic acid reduces bleeding and the amount of blood product use in patients undergoing emergent isolated CABG surgery.

Anahtar Kelimeler

CABG, Desmopressin, Tranexamic Acid

Kaynakça

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