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Abacilar A.,Izmir University | Atalay H.,Mersin Private Meadleeast Hospital | Dogan O.F.,Adana Numune Education and Training Hospital
Indian Journal of Nephrology | Year: 2015

Vascular access is used as a lifeline for hemodialysis in patients with end stage renal disease failure (ESRD). Failure of arteriovenous fistula (AVF) maturation is still high. The purpose of this study was to research the effects of clopidogrel in combination with oral iloprost, a synthetic analog of prostacyclin PGI2. Ninety-six diabetic ESRD patients were divided into two groups. In the first group (Group 1, N = 50), clopidogrel (75 mg daily dose) and an oral prostacycline analog (200 mg daily dose) were administered. In the second group (Group 2, N = 46), placebo was given. All patients took study medication 7-10 days prior to surgery. A Doppler ultrasound (USG) was performed for measurement of arterial and venous diameters, and peak systolic velocity of arterial flow based on subsequent fistula adequacy. Autogenous AVFs were constructed in forearm as distally as possible in all patients. Both groups were followed-up for a year. In the placebo group, early AVF thrombosis was detected in two patients (4.3%). AVF maturation failure was noted in 14 patients (30.4%) in placebo group and in four patients (8%) in clopidogrel plus oral prostacycline analog group in the early postoperative period (P = 0.001). The mean maturation time was 38 ± 6.5 and 53 ± 12.8 days in study and placebo groups, respectively (P = 0.023). The mean blood flow was 352 ± 94 mL/min in placebo group and 604 ± 125 mL/min in study group (P = 0.001). The arterial end diastolic velocity was 116 ± 14 cm/s in study group and 72 ± 21 cm/s in placebo group (P = 0.036) 1 year after the surgery. Our data indicated that clopidogrel and oral prostacycline analog combination is effective and safe for the prevention of primary AVF failure in hemodialysis patients and decreased acute and chronic thrombotic events. © 2015, Medknow Publications. All rights reserved. Source


Atalay H.,Mersin Private Middle East Hospital | Dogan O.F.,Adana Numune Education and Training Hospital
Open Cardiovascular Medicine Journal | Year: 2015

Background: Severe beeding which requiring massive blood transfusion after emergent beating heart surgery is shown to be 1–3%. Therefore, complications and side effects of transfusion can be seen. The aim of this study was to investigate the effectiveness of Ankaferd blood clotter (ABC) as a new topical herbal blood clotter to decrease mediastinal bleeding in emergent beating heart CABG patients who medicated with clopidogrel and acetyl salisilic acite (ASA) prior to CABG surgery. Materials and Methods: 25 CABG patients received a high dose clopidogrel (600 mgr) and 300 mgr ASA have been included into the study (ABC group). 25 patients have also been included into the study for comparison (placebo group, PG). After the administration of protamine sulphate, a 10 ml of ABC solution has been sprayed to the surgical area including mediastinum and epicardial sac. We compared mediastinal drenaige, reoperation due to tamponade, and required blood and blood products in both groups. Results: The mean amount of bleeding after operation was 230 ml in ABC group, and 490 ml in CG (P=0.001). In ICU, bleeding in ABC group and CG was 410ml and 680ml, respectively (P=0.0022). The mean total bleeding from mediastinum was 530±280 mL and 990±440 mL In ABC and CG group, respectively (P=0.001). The amount of autotransfusion was as follows: 175 mL in ABC group, and 290 mL in CG (P=0.002). No patient needed the surgical revision in ABC group, but four patients (16%) from CG group because of cardiac tamponade. Seventeen patients from CG required blood transfusion due to low hematocrite level postoperatively. In CG, the mean hematocrite level was 17±2,3. Transfusion of fresh frozen plasma and platelets in ABC group and CG were as follows: 0.2 and 0 in ABC group, and 0.3and 0.4 in CG. Conclusion: Our study showed that the local use of 10 mL ABC reduces bleeding significantly. Therefore, transfusion requirements of PRBC, platelets, and total blood units in patients on clopidogrel and ASA undergoing emergent beating heart CABG. To provide cardiac tamponade because of excessive mediastinal bleeding and requirement of blood transfusion after emergent CABG patients who previously administered clopidogrel and ASA, we propose local use of ABC solution as a potent coagulant agent. © Dogan et al. Source


Akpinar M.B.,Izmir University | Atalay A.,Cukurova University | Atalay H.,Mersin Private Middle East Hospital | Dogan O.F.,Adana Numune Education and Training Hospital
Heart Surgery Forum | Year: 2015

Background: The risk of reoperation due to bleeding after open heart surgery is 2.2%-4.2%. Extracorporeal circulation and emergency operations are the important risk factors. In coronary artery bypass graft (CABG) patients who are treated preoperatively with antiplatelets plus clopidogrel are the sources of postoperative bleeding. The aim of this study was to research the effect of local Ankaferd blood stopper (ABS) to prevent mediastinal bleeding in on-pump CABG patients who were treated with clopidogrel and acetylsalicylic acid (ASA) preoperatively. Methods: Twenty-five emergency CABG patients premedicated with clopidogrel and ASA were included in the study (Group 1). An additional twenty-five patients who were premedicated with the same antiplatelet agents were selected as a control group (Group 2). At the end of the surgery, 4-10 mL of ABS solution was applied on the mediastinal and epicardial tissue following protamine administration in Group 1. We compared postoperative total mediastinal bleeding, reoperation rate and total blood and blood products transfused between the two groups. Results: There was no mortality in either of the two groups. Mean postoperative bleeding was 430 mL in the ABS group, and 690 mL in the CG group (P = .044). In the ICU, bleeding in groups 1 and 2 was 610 mL and 980 mL, respectively (P = .025); total bleeding from the mediastinum was 830 mL and 1490 mL, respectively (P = .001) and the amount of autotransfusion was 210 mL and 400 mL (P = .003). Total transfusion of PRBCs in the operating room in groups 1 and 2 was 0.3 and 0.8, respectively (P = .003). No patients in the ABS group needed surgical revision due to severe bleeding or cardiac tamponade. Conclusion: The use of local ABS reduces bleeding, transfusion requirements of packed red blood cells, platelets and total blood units in patients premedicated with clopidogrel and ASA undergoing emergent CABG. © 2015 Forum Multimedia Publishing, LLC. Source


Cakir H.,Ataturk University | Uncu H.,Adana Numune Education and Training Hospital | Gur O.,Namik Kemal University | Yurekli I.,Ataturk University | And 2 more authors.
International Heart Journal | Year: 2014

In this study, we examined the early results for patients who underwent beating heart coronary bypass surgery and compared these results with those of conventional coronary bypass surgery. A total of 1094 patients who underwent isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic were included in this study. Seventy-three patients in whom cardiopulmonary bypass was not used (group 1) were compared to 1021 patients in whom cardiopulmonary bypass was used (group 2). The mean age was 60.7 ± 9.3 in group 1 and 58.9 ± 9.7 in group 2 (P > 0.05). There was no signifi cant difference between the two groups in terms of gender, or the coexistence of diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and hypertension (P > 0.05). There was no signifi cant difference between group 1 and group 2 in terms of development of postoperative atrial fi brillation (AF), use of an intra-aortic balloon pump, need for re-operation for bleeding, or duration of hospital stay and intensive care unit stay (P > 0.05). The need for inotropic support and the amount of mediastinal drainage were less in group 1 than in group 2 (P = 0.002, P < 0.001). The incidences of postoperative cerebrovascular accident, development of chronic renal failure, and sternal wound infection did not signifi cantly differ between the groups (P > 0.05). There was no mortality in group 1, whereas it was calculated as 1.8% in group 2 (P = 0.63). Beating heart coronary artery bypass surgery decreases the need for inotropic support and transfusion. Source


Cakir H.,Ataturk University | Uncu H.,Adana Numune Education and Training Hospital | Gur O.,Namik Kemal University | Gur D.O.,Tekirdag State Hospital | And 2 more authors.
Advances in Clinical and Experimental Medicine | Year: 2014

Objectives. The study was aimed at investigating the risk factors of using an intraaortic balloon pump (IABP) in coronary artery bypass surgery and presenting the authors' clinical experience of IABP use. Material and Methods. The study included 1094 patients who underwent coronary artery bypass surgery at the authors' clinic between January 2009 and December 2011. A comparison was made between 17 patients in whom an IABP was used and 1077 patients in whom it was not used. Results. An intraaortic balloon pump was used in 17 patients (1.55%) out of 1094 patients who underwent isolated coronary artery bypass surgery. The ratio of patients who had had preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50% and emergency surgery in Group 1 were higher than in Group 2 (p < 0.05). The total cardiopulmonary bypass time of Group 1 was found to be longer than that of Group 2 (p < 0.05). The demand for inotropics after weaning from cardiopulmonary bypass was greater in Group 1 than in Group 2 (p < 0.05). The need for reoperation (because of bleeding) was higher in Group 1 than in Group 2 (p < 0.05). The patients' stay on the intensive care unit was longer in Group 1 than in Group 2 (p < 0.05). Mortality rates were 29.4% in Group 1 and 1.2% in Group 2 (p < 0.05). Conclusions. Preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50%, emergency surgery and long cardiopulmonary bypass time are important risk factors for IABP use in coronary artery bypass surgery. © Copyright by Wroclaw Medical University. Source

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