Effects of acute normovolemic hemodilution on perioperative coagulation and fibrinolysis in elderly patients undergoing hepatic carcinectomy

Department of Anesthesiology, Lihuili Hospital, Medical School of Ningbo University, Ningbo 315040, China. jianrguo@126.com

Chinese Medical Sciences Journal [Chung-Kuo I HsüEh K'o HsüEh Tsa Chih / Chinese Academy of Medical Sciences]. 2010;25((3):):146-50.
OBJECTIVE To observe the effects of acute normovolemic hemodilution (ANH) on coagulation function and fibrinolysis in elderly patients undergoing hepatic carcinectomy. METHODS Thirty elderly patients (aged 60-70 years) with liver cancer (American Society of Anesthesiologists physical status I-II) scheduled for hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n = 15) and control group (n = 15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (HES) (130/0. 4), and basic liquid containing 6% HES and routine Ringer's solution, respectively. In all the studied patients, blood samples were drawn at five different time points: before anesthesia induction (T1), 30 minutes after ANH (T2), 1 hour after start of operation (T3), immediately after operation (T4), and 24 hours after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (activated GPIIb/GPIIIa and P-selectin) were measured. RESULTS The perioperative blood loss was not significantly different between the two groups (P > 0. 05). The volume of allogeneic blood transfusion in ANH group was significantly smaller than that in control group (350. 5 +/- 70. 7 mL vs. 457. 8 +/- 181. 3 mL, P < 0. 01). Compared with the data of T1, prothrombin time (PT) and activated partial thromboplastin time in both groups prolonged significantly after T3 (P < 0. 05), but still within normal range. There were no significant changes in thrombin time and D-dimer between the two groups and between different time points in each group (all P > 0. 05). SFMC and F1 + 2 increased in both groups, but without statistical significance. P-selectin expression on the platelet surface of ANH group was significantly lowered at T2 and T3 compared with the level at T1 (P < 0. 05). Compared with control group, P-selectin was significantly lower in ANH group at T2-T5 (all P < 0. 05). CONCLUSIONS In elderly patients undergoing resection of liver cancer, ANH may not hamper fibrinolysis and coagulation function. It could therefore be safe to largely reduce allogeneic blood transfusion.
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