Changes in coagulation hemostasis when using colloidal solutions during off-pump coronary artery bypass grafting surgery

  • P.V. Gurin
Keywords: coagulation hemostasis, hydroxyethyl starch solutions, 4% gelatin solution, perioperative blood loss, thromboelastometry


The results of the use of colloidal and crystalloid solutions during surgical intervention of patients with coronary heart disease are presented. The effect of colloidal solutions on the coagulation hemostasis system and the associated perioperative complications were studied. The study included 60 patients operated in the NIST named after O.O. Shalimov on coronary heart disease who underwent off-pump coronary bypass grafting surgery: 40 patients (in the intraoperative period solutions of hydroxyethyl starch 130/0.4 were used (20 patients) and 4% gelatin (20 patients) were used in the intraoperative period); the comparison group included 20 patients (only crystalloid solutions were used in the intraoperative period). The results of general and biochemical analysis of blood, electrolyte, acid-base and gas composition of blood were analyzed, prothrombin time was determined, prothrombin index, international normalized ratio, activated partial thromboplastin time, thromboelastometry. The statistical analysis of the material was carried out using standard methods using the application package “MS Excel” and “StatPlus 2007 Professional”. Evaluated the average, standard errors, the authenticity of the differences. To estimate the intergroup difference, the parametric t-criterion of the Student was used, while the links between the indicators were determined - a correlation analysis by Pierson. The results obtained showed a negative effect on the coagulation hemostasis system of colloidal solutions (changes in the thromboelastometry, prothrombin time and index) and an increase in the frequency of postoperative complications (blood loss, the need for blood transfusion, prolonged stay in the intensive care unit and hospital). The results of the study provide a perspective in the further study of the effect of colloidal solutions on coagulation hemostasis during other surgical interventions (thoracic, abdominal, etc.), as well as the use of the thromboelastometry method in clinical practice for early diagnosis of coagulation hemostasis disorders.


1. Bayer, O., Schwarzkopf, D., Doenst, T., Cook, D., Kabisch, B., Schelenz, C. … Hartog, C. S. (2013). Perioperat ive f luid therapy with tetrastarch and gelatin in cardiac surgery – a prospective sequential analysis. Crit. Care Med., 41 (11), 2532–42. doi: 10.1097/CCM.0b013e3182978fb6.

2. Heming, N., Elatrous, S., Jaber, S., Dumenil, S. & Cousson, J. (2017). Haemodynamic response to crystalloids or colloids in shock: an exploratory subgroup analysis of a randomised controlled trial. BJA, 6 (12), 55–61. Retrieved

3. Hung, M. H., Zou, C., Lin, F. S., Lin, C. J., Chan, K. C. & Chen, Y. (2014). New 6% hydroxyethyl starch 130/0.4 does not increase blood loss during major abdominal surgery – a randomized, controlled trial. J. Formos Med, Assoc., 113, 429–435. doi: 10.1016/j.jfma.2012.08.002.

4. Joosten, A., Delaporte, A., Ickxm, B., Touihri, K., Stany, I., Barvais, L. … Van der Linden, P. (2018). Crystalloid versus colloid for intraoperative goal-directed fluid therapy using a closed-loop system: A randomized, double-blinded, controlled trial in major abdominal surgery. Anesthesiology, 128 (1), 55–66. doi: 10.1097/ALN.0000000000001936.

5. Matharu, N. M., Butler, L. M., Rainger, G. E., Gosling, P., Vohra, R. K. & Nash, G. B. (2008). Mechanisms of the anti- inflammatory effects of hydroxyethyl starch demonstrated in a flow-based model of neutrophil recruitment by endothelial cells. Crit. Care Med., 36 (5), 1536–42. doi: 10.1097/CCM.0b013e318169f19a.

6. Myburgh, J. A., Finfer, S., Bellomo, R., Billot, L., Cass, A., Gattas, D. … Webb, S. A. (2012). Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N. Engl. J. Med., 367, 1901–11. doi: 10.1056/NEJMoa1209759.

7. Patel, A., Waheed, U. & Brett, S. J. (2013). Randomised trials of 6% tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis. Int. Care Med., 39, 811–822. doi: 10.1007/s00134-013-2863-6.

8. Rasmussen, K. C., Johansson, P. I., Hoejskov, M., Kridina, I., Kistorp, T., Thind, P., Secher, N. H. (2014). Hydroxyethyl starch reduces coagulation competence and increase blood loss during major surgery. Results from a randomized controlled trial. Ann Surg., 2, 249–254. doi: 10.1097/SLA.0000000000000267.

9. Van Der Linden, P., James, M., Mythen, M. & Weiskopf, R. B. (2013). Safety of modern starches used during surgery. Anesthesia &Analgesia, 116 (1), 35–48. doi: 10.1213/ANE.0b013e31827175da.

10. Zangrillo, A., Gerli, C., Landoni, G., Sparicio, D., Roberti, A., Sottocorna, O. … Crescenzi, G. (2006). Anesthesiological management and outcome of 100 “beating heart” coronary artery bypass grafting. Minerva Anestesiol., 72 (10), 827–39. Retrieved from
How to Cite
Gurin, P. (2018). Changes in coagulation hemostasis when using colloidal solutions during off-pump coronary artery bypass grafting surgery. Reports of Vinnytsia National Medical University, 22(3), 431-435.