ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The effect of acute normovolemic hemodilution on plasma fibrinogen level in coronary artery bypass grafting
Başar Erdivanlı1, Ahmet Şen1, Tolga Koyuncu1, Şaban Ergene2, Abdullah Özdemir1, Ersagun Tuğcugil1
1Departments of Anaesthesiology and Reanimation, Medical Faculty of Recep Tayyip Erdoğan University, Rize, Turkey
2Departments of Cardiovascular Surgery,Medical Faculty of Recep Tayyip Erdoğan University, Rize, Turkey
DOI : 10.5606/tgkdc.dergisi.2017.13205
Background: This study aims to investigate the effect of acute normovolemic hemodilution on reduced plasma levels of fibrinogen.

Methods: We retrospectively evaluated data of a total of 101 adult patients (68 males, 33 females; mean age 61±8 years; range 46 to 84 years) who underwent elective coronary artery bypass grafting surgery between January 2014 and December 2015. A comparison was made between patients who received acute normovolemic hemodilution (ANH group, n=49) and patients who did not (control group, n=52) matched by predictors of mortality and postoperative bleeding.

Results: The mean decline in fibrinogen in ANH group (27.4±13.8%) was significantly lower, compared to the control group (43.7±9.5%, 95% CI: -21.4 to -11.3, p<0.0001). The mean decline in platelet count in ANH group (33.1±10.1) was similar to control group (35.6±8.9) (p=0.21). The whole blood was not re-transfused to 10 patients (20.4%) in ANH group at the end of surgery and preserved to be used in the intensive care unit. During intensive care unit stay, only eight patients (16.3%) in ANH group received allogeneic red blood cell, while 41 patients (78.8%) in the control group (p<0.0001). Only 14 patients (28.6%) in ANH group received allogeneic fresh frozen plasma, while all patients in the control group received (p<0.0001). No mortality was seen in either group.

Conclusion: Acute normovolemic hemodilution may preserve plasma levels of fibrinogen and reduce the need for allogeneic transfusion of blood products in patients with adequate preoperative fibrinogen level.

Keywords : Acute normovolemic hemodilution; blood transfusion; coronary artery bypass; fibrinogen
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