Procedure and assessment of hemostasis
bleeding
OOZING, BLEEDING, BLEEDING, ACUTE DISSEMINATED INTRAVASCULAR COAGULATION
Baseline testing within 24 h prior to surgery included a complete blood count with differential, the activated partial thromboplastin time (aPTT), the prothrombin time, an electrolyte panel and a hepatic or renal panel. Patient enrollment occurred in the operating room when an aortocoronary bypass was determined. After full median sternotomy, heparin (0.7–1.0 mg/kg) was administered to achieve the target activated clotting time (ACT; > 300 s).In all patients, a saphenous vein or radial artery graft was anastomosed to the aorta using the Heartstring device (MAQUET Holding B.V. & Co. KG, Rastatt, Germany) at the beginning of a surgery. As soon as identification of bleeding of the aorto-graft anastomosis site, we applied treatment regimen with one of the two hemostatic agents, GHM or CHM, using a block randomization system. The topical hemostatic agents were specially prepared with the same dose and same color. The containers containing the solutions were then sent to the operating room with only an ID number, which marking was removed, making it impossible to identify them when used in the operating room. These hemostatic agents were delivered to the operating room in a sealed envelope by the nurse. The selected agent was delivered to the site of bleeding, followed by light compression with a wet gauze until hemostasis was achieved.We defined the hemostatic status on aorto-graft anastomosis site using the three levels (0: Dry, 1: Oozing, and 2: Pooling) of the Surface Bleeding Severity Scale. [Application of CHM to an aortocoronary anastomosis. The yellow box depicts the application process. The inset shows the treatment areaProtamine was administered at the end of the OPCAB procedure. After the completion of the anastomoses, residual heparin was reversed with 1 mg of protamine for every mg of heparin used for systemic heparinization. Following protamine administration, the ACT was assessed at 3, 15, and 30 min. If an additional dose of protamine was required, the quantity of protamine and resultant ACT 10 min after completion of the additional dose were recorded. The pericardium was loosely closed after the surgery, the midline sternotomy was closed in layers, and two mediastinal drains were retained.Participants in both groups took 100 mg aspirin and 75 mg clopidogrel daily from the first postoperative day. Patients with hemoglobin (Hb) values below 60 g/L received transfusion therapy. In stable patients with Hb values between 60 and 100 g/L, an evaluation of the patients’ clinical status was necessary to determine if transfusion was warranted. Transfusion of fresh frozen plasma (FFP) was indicated for the following: an international normalized ration (INR) greater than 1.5; microvascular bleeding in patients who underwent massive transfusion; and acute disseminated intravascular coagulation in the presence of ongoing bleeding. Transfusion of platelet concentrates was indicated if the platelet count was below 50 × 10