Circulation journal : official journal of the Japanese Circulation Society
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Randomized Controlled Trial
Effect of hydroxyethyl starch 130/0.4 on blood loss and coagulation in patients with recent exposure to dual antiplatelet therapy undergoing off-pump coronary artery bypass graft surgery.
Hydroxyethyl starch (HES) solutions are often used for maintaining intravascular volume and improving microperfusion, while a large amount of HES can cause adverse effects on coagulation. As the indications for clopidogrel expand, an increasing number of patients undergoing off-pump coronary artery bypass surgery (OPCAB) are also undergoing dual antiplatelet therapy (DAPT), with its higher risk of bleeding complications. The aim of the present study was to determine whether a moderate dose of 6% HES 130/0.4 significantly increases perioperative blood loss in patients with continued DAPT within 5 days of OPCAB. ⋯ Up to 30 ml·kg⁻¹·day⁻¹ of 6% HES 130/0.4 did not increase the perioperative blood loss compared to crystalloid in patients with recent exposure to DAPT undergoing OPCAB. HES 130/0.4 caused a similar degree and duration of coagulation impairment as observed when only crystalloid was given.
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For several decades, based on clinical trials comparing coronary-artery bypass grafting (CABG) with medical therapy, bypass surgery has been regarded as the treatment of choice for patients with unprotected left main coronary artery (LMCA) disease. However, because of marked advancements in the techniques of percutaneous coronary intervention (PCI) with stenting and CABG and adjunctive pharmacologic therapy, reevaluation and review of current indications for optimal revascularization therapy for LMCA disease are required to determine the standard of care for these patients. ⋯ In addition, these data not only may change future guidelines, but support the need for prospective, large randomized trials comparing the 2 revascularization treatments. Finally, this evidence will change the current clinical practice of revascularization strategy for unprotected LMCA disease.