Blood-saving Effect Of Tranexamic Acid And Platelet-rich Plasma On Perioperative Patients Undergoing Type A Aortic Dissection Surgery

Objective To investigate the blood-saving effect on patients undergoing acute Stanford type A aortic dissection surgery and evaluate its safety.Methods The study was a prospective, randomized, single blind and placebo-control study. Using a computer-generated randomization schedule, a total of 56 patients with acute Stanford type A aortic dissection, aged 46±12 yr, weighting 73±11 kg were randomly divided into two groups: tradition treatment group(group C, n=26)and tranexamic Acid group(group TXA, n=30). Routine and unified measures of blood-saving were applied in group C. On the basis of it, tranexamic acid 10 mg/kg was intravenously infused before skin incision, followed by continuously at 10 mg.kg-1.h-1 until the end of operation in group TXA.While the equal volume of normal saline was given instead in group C with the same method of tranexamic acid used in group TXA. Hb, platelet count and platelet function, PT and APTT were measured at pre-induction(T1), before cardiopulmonary bypass(T2), after cardiopulmonary bypass(T3), 6 hour(T4)and 24 hour(T5)after operation. The total volume of chest tube drainage at 24 h after operation and the volume of allogeneic blood transfused after operation were recorded, a second thoracotomy for stopping the bleeding and the other complications after operation were also recorded.Results PT and APTT at T3、T4 in the group TXA were not significantly shortened than in group C(P>0.05). Compared with group C, the total volume of chest tube drainage at 24 h after operation and the incidence of a second thoracotomy for stopping the bleeding after operation were significantly decreased in group TXA(806.1±109.1 ml VS 1165.4±232.5 ml, P<0.05, 0 VS 4(15.4%), P<0.05), the volume of allogeneic red blood cells, fresh frozen plasma and platelet were significantly decreased in group TXA(3.1±1.1 u VS 5.2±2.3 u, P<0.05, 538.1±68.5 ml VS 895.9±105.2 ml, P<0.05, 1.2±0.1 u VS 2.5±0.6 u, P<0.05). The incidence of acute lung injury and transient neurologic dysyndrome after operation were significantly lower in group TXA than in group C(8(26.6%) VS 12(46.2%), P<0.05, 8(26.7)VS 11(42.3), P<0.05), the time of mechanical ventilation and ICU stay time were significantly lower in group TXA than in group C(51.3±3.1 h VS 79.6±5.2 h, P<0.05, 3.9±1.1 d VS 6.5±2.6 d, P<0.05). There was no significant difference in the other indicators between the two groups(P>0.05).Conclusion Tranexamic acid applied safely to Stanford type A aortic dissection surgery can reduce postoperative bleeding and the amount of allogeneic blood transfusion, with a blood-saving effect, which does not increase the postoperative complication.Objective To investigate the blood-saving effect of acute preoperative autologous platelet-rich plasma and back-transfusion on patients undergoing Stanford type A aortic dissection surgery.Methods 59 consecutive patients undergoing Stanford type A aortic dissection surgery between January 2013 and October 2015, ASAⅡ-Ⅲ, aged 32-59 yr, weighting 63-95 kg were randomly divided into two groups: tradition group(group T, n=31) and autologous platelet-rich plasmapheresis group(group a PRP, n=28). Hb, platelet count and platelet function, PT and APTT were measured at preinduction(T1), before cardiopulmonary bypass(T2), after cardiopulmonary bypass(T3), 1hour(T4), 24 hour(T5) and 48 hour(T6) after operation. The volume of allogeneic blood transfused in operation and 48 h after operation and the total volume of chest tube drainage 48 h after operation were recorded. The complications after operation were also recorded.Results The volume of the whole blood processed for autologous platelet-rich plasmapheresis in group a PRP was(1269±197) ml, a PRP(753±78) ml, the platelet count accounts for(22±3)% of the total number of Plt in the whole blood volume. Compared with group T, Hb at T2 in group a PRP was significantly decreased, platelet count at T3 was significantly reduced((101±10 g/l vs 131±15 g/l, 83±23×109 /L vs 115±51×109 /L, P<0.05), while platelet count at T4、T5、T6 was significantly increased((103±25×109 /L vs 151±27×109 /L, 105±25×109 /L vs 147±39×109 /L, 101±26×109 /L vs 149±35×109 /L, P<0.05), platelet function at T4、T5、T6 was significantly enhanced((1.93±0.58 vs 2.73±1.13, 2.23±0.96 vs 2.83±0.75, 3.05±1.15 vs 3.07±1.12, P<0.05). PT and APTT was significantly shortened((17.6±2.1 s vs 14.1±1.1 s, 17.6±2.7 s vs 13.5±0.8 s, 42±7 s vs 36±3 s, 39±8 s vs 33±3 s, P<0.05), P<0.05). The volume of intraoperative blood platelet, plasma and cold precipitation transfused, postoperative red blood cells, platelets, plasma and cold precipitation transfused as well as the total volume of chest tube drainage 48 h after operation in group a PRP were significantly less than in group T((3.3±2.1 u vs 1.5±1.1 u, 321±53 ml vs 205±31 ml, 5.1±2.5 u vs 1.5±0.6 u, P<0.05), 4.3±1.9 u vs 2.5±1.2 u, 3.1±1.3 u vs 1.1±0.5 u, 413±59 ml vs 231±23 ml, 3.3±1.7 u vs 1.5±0.8 u, 1565.4±232.7 ml vs 1106.7±109.5 ml, P<0.05). Compared with group T, the incidence of postoperative acute lung injury in group a PRP was obviously decreased(9(32.1%) vs 6(19.4%), P<0.05), mechanical ventilation time and ICU stay time was obviously shortened((69.1±5.9 h vs 43.1±1.5 h, 8.1±2.8 d vs 5.3±1.1 d, P<0.05). There was no statistically significant difference with to the other postoperative indicators(P>0.05).Conclusion Acute preoperative autologous platelet-rich plasmapheresis and back-transfusion can significantly reduce the amount of postoperative bleeding and allogeneic blood transfusion undergoing type A aortic dissection surgery, with a obvious blood-saving effect.