Safe and Effective Blood Preservation Through Acute Normovolemic Hemodilution and Low-Dose Tranexamic Acid in Open Partial Hepatectomy

Jian Yang; Jing Zhang; Jiayan Luo; Jie Ouyang; Qicai Qu; Qitao Wang; Yongyu Si

doi:10.2147/JPR.S426872

Safe and Effective Blood Preservation Through Acute Normovolemic Hemodilution and Low-Dose Tranexamic Acid in Open Partial Hepatectomy

J Pain Res. 2023 Nov 15:16:3905-3916. doi: 10.2147/JPR.S426872. eCollection 2023.

Authors

Jian Yang^#¹, Jing Zhang^#¹, Jiayan Luo², Jie Ouyang¹, Qicai Qu¹, Qitao Wang¹, Yongyu Si¹

Affiliations

¹ Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101, People's Republic of China.
² Department of Anesthesiology, People's Hospital of Yanting, Sichuan, 621600, People's Republic of China.

^# Contributed equally.

Abstract

Objective: In this study, we evaluated the efficacy of tranexamic acid (TXA) and acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch (130/0.4) in minimizing blood loss during open partial liver resection. Coagulation function was assessed using thromboelastography (TEG) and hemostasis tests, while renal function changes were tracked through serum creatinine values post-surgery.

Methods: Thirty patients undergoing open partial liver resection were allocated to two groups: Group T received TXA + ANH, and Group A received ANH alone. Blood was drawn from the radial artery under general anesthesia. Both groups received peripheral vein injections of 6% hydroxyethyl starch 130/0.4. Group T additionally received intravenous TXA. Primary outcomes included blood loss and allogeneic blood transfusions. TEG assessed coagulation status and renal function was monitored.

Results: Group T demonstrated superior outcomes compared to Group A. Group T had significantly lower intraoperative blood loss (700 mL vs 1200 mL) and a lower bleeding rate per kilogram of body weight (13.3 mL/kg vs 20.4 mL/kg). Coagulation parameters favored Group T, with higher TEG maximum amplitude (55.91 mm vs 45.88 mm) and lower activated partial thromboplastin time (38.04 seconds vs 41.49 seconds). Neither group experienced acute renal injury or kidney function deficiency during hospitalization.

Conclusion: TXA and ANH in a small dose during liver resection stabilize clotting, reduce blood loss by 6% compared to hydroxyethyl starch 130/0.4, and do not affect renal function.

Keywords: acute normovolemic hemodilution; coagulation function; liver resection; thromboelastography; tranexamic acid.

Grants and funding

This study was funded by Hospital Science and Technology Foundation (NO. 2021yk005). The funding body had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.