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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 1155-1162, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
TM Yau, S Carson, RD Weisel, J Ivanov, Z Sun, R Yu, MF Glynn and SJ Teasdale
The effects of normothermic systemic perfusion (35 degrees to 37 degrees C;
n = 73) were compared with those of moderately hypothermic systemic
perfusion (25 degrees to 29 degrees C; n = 73) with respect to blood loss,
transfusion requirements, and platelet levels in 146 patients undergoing
isolated, primary coronary artery bypass grafting. In addition, most
patients were given an antifibrinolytic medication during operation as
follows: tranexamic acid (10 gm intravenously; n = 63),
epsilon-aminocaproic acid (15 gm intravenously; n = 63), or no drug as a
control. (n = 20). Normothermic patients tended to bleed less at 24 hours
(warm, 864 +/- 42 ml and cold, 918 +/- 68 ml), but these differences were
not statistically significant. Patients receiving either tranexamic acid or
epsilon-aminocaproic acid, regardless of perfusion temperature, bled less
after 6, 12, and 24 hours than did cold control patients (p less than
0.05). Warm control patients also bled less than did cold control patients
after 6 or 12 hours (p less than 0.05), and neither drug further reduced
blood loss in these patients. Circulating platelet levels were better
preserved in patients receiving either tranexamic acid or
epsilon-aminocaproic acid and in patients with warm perfusion and no drug
than in cold control patients. Normothermic systemic perfusion, tranexamic
acid, and epsilon- aminocaproic acid each reduced postoperative blood loss
and preserved platelets.
ARTICLES
The effect of warm heart surgery on postoperative bleeding
Division of Cardiovascular Surgery, Toronto Hospital, Ontario, Canada.
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