Effects of combined balanced colloid and crystalloid on rotational thromboelastometry in vitro

Ac, Lindroos; Aa, Schramko; Niiya, Tomohisa; Rt, Suojaranta-Ylinen; Tt, Niemi

doi:10.1177/0267659111409277

Cited by 7 publications

(7 citation statements)

References 26 publications

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“…Data in the present report does not therefore support any clear advantage of one osmotherapeutic over the other. Nevertheless, findings in this study appear to corroborate results from two previous in vitro human studies, which demonstrated hypocoagulability caused by 15 % mannitol that was more pronounced than that caused by 2.5 % HTS or by a combination of hydroxyethyl starch with 15 % mannitol using ROTEM [ 12 , 34 ].…”

Section: Discussionsupporting

confidence: 91%

In vitro effects of 3 % hypertonic saline and 20 % mannitol on canine whole blood coagulation and platelet function

2015

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BackgroundHyperosmolar therapy, using either mannitol or hypertonic saline (HTS), is considered the treatment of choice for intracranial hypertension. However, hyperosmolar agents may impair coagulation and platelet function, limiting their use in patients at risk for hemorrhage. Despite this, studies evaluating the effects of mannitol compared to other hyperosmolar agents in dogs are largely lacking. The aim of this study was to compare the in vitro effects on global hemostasis and platelet function of 20 % mannitol and 3 % HTS on canine blood.MethodsCitrated whole blood from 15 healthy dogs was diluted with 0.9 % saline, 20 % mannitol and 3 % HTS in ratios of 1:16 and 1:8. Rotational thromboelastometry (ROTEM) was used to assess clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) following extrinsic activation (Ex-tem) and after platelet inhibition (Fib-tem). A platelet function analyzer (PFA-100) was used to assess closure time (CtPFA).ResultsNo significant differences were observed between untreated whole blood and samples diluted with saline. Samples diluted with both mannitol and HTS were hypocoagulable compared to untreated whole blood samples. At a dilution of 1:16, no significant differences were found between any measured parameter in samples diluted with saline compared to mannitol or HTS. At a 1:8 dilution, CtPFA was prolonged in samples diluted with mannitol and HTS compared to saline, and CtPFA was prolonged more with mannitol than HTS. Ex-tem CT was increased at a 1:8 dilution with mannitol compared to HTS. Ex-tem CFT was prolonged at a 1:8 dilution with both agents compared to saline, and was prolonged more with mannitol than HTS. Ex-tem MCF was reduced at a 1:8 dilution with both agents compared to saline.Discussion and ConclusionsData in this study indicate that both mannitol and HTS affect canine platelet function and whole blood coagulation in vitro in a dose-dependent fashion. The most pronounced effects were observed after high dilutions with mannitol, which impaired platelet aggregation, clot formation time, clot strength, and fibrin formation significantly more than HTS. Further in vivo studies are necessary before recommendations can be made.

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Section: Discussionsupporting

confidence: 91%

In vitro effects of 3 % hypertonic saline and 20 % mannitol on canine whole blood coagulation and platelet function

2015

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“…Gelatin colloids have been associated with hypocoagulability in humans both in vitro ( 21 , 22 ) and in vivo ( 23 ). In vitro dilution studies comparing gelatin to HES colloids have shown greater hypocoagulability with HES ( 21 , 22 , 24 ), suggesting gelatin may be the preferred colloid. The effects of gelatin colloids on coagulation in dogs have not been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

et al. 2018

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Background: Hemorrhagic shock and volume replacement can alter coagulation. Synthetic colloids, hydroxyethyl starch (HES), and gelatin, may enhance hypocoagulability. Our primary objective was to describe the effect of four fluid products on coagulation in canine hemorrhagic shock. Our secondary objective was to compare measurements of coagulation during shock to baseline in all dogs.Methods: Anesthetized greyhounds subjected to atraumatic hemorrhage for 60 min were administered 20 mL kg−1 of either fresh whole blood (FWB), 6% HES 130/0.4, 4% succinylated gelatin (GELO), or 80 mL kg−1 of isotonic crystalloid over 20 min (n = 6 per group). Platelet closure time (PCT), rotational thromboelastometry (ROTEM) and plasma coagulation assays were measured at baseline, end of hemorrhage (shock), and 40 (T60), and 160 (T180) min after study fluid. ROTEM parameters included clotting time (CT), clot formation time (CFT), alpha angle, maximum clot firmness (MCF), lysis index at 60 min (LI60), and thrombodynamic potential index (TPI) for INTEM, EXTEM, FIBTEM (MCF only), and APTEM (LI60 only) profiles. Plasma coagulation assays included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen concentration and activities of factor VII (FVII), factor VIII (FVIII), and von Willebrand Factor antigen (vWF). Between-group differences were tested using linear mixed models with post-hoc between-group comparisons (Bonferroni-Holm corrected). Differences between baseline and shock were tested using paired t-tests. Significance was set at P < 0.05.Results: GELO showed longer PCT at T60, compared with FWB and CRYST, and at T180, compared with all other groups. HES showed longer EXTEM CT at T60, compared with all other groups. HES showed lower INTEM and EXTEM MCF at T60 and lower INTEM MCF at T180, compared with FWB. Some plasma coagulation assays showed greater hypocoagulability with HES. Comparing shock to baseline, EXTEM CT, INTEM CFT, EXTEM CFT, PT, and FVIII significantly increased and PCT, INTEM CT, INTEM MCF, EXTEM MCF, EXTEM LI60, EXTEM TPI, FIBTEM MCF, APTT, fibrinogen, FVII, and vWF significantly decreased.Conclusions: In dogs with hemorrhagic shock, volume replacement with GELO caused mild platelet dysfunction and HES was associated with coagulation changes consistent with hypocoagulability, beyond effects of hemodilution. Shock alone produced some evidence of hypocoagulability.

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“…This might be explained by higher than aimed Hb levels. It has been shown before that clot strength reduces when using hydroxyethyl starch (HES)-based colloids, 21,22 and after abandoning HES solutions in surgical fluid management in the authors' institution, albumin (4% and 20% solutions) is the only choice of colloid. This in addition to the authors' patients' lack of underlying coagulation disturbances ensure proper clotting during perioperative period.…”

Section: Discussionmentioning

confidence: 99%

Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study

Laine

Niemi

Schramko

2018

Journal of Cardiothoracic and Vascular Anesthesia

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Effects of combined balanced colloid and crystalloid on rotational thromboelastometry in vitro

Cited by 7 publications

References 26 publications

In vitro effects of 3 % hypertonic saline and 20 % mannitol on canine whole blood coagulation and platelet function

In vitro effects of 3 % hypertonic saline and 20 % mannitol on canine whole blood coagulation and platelet function

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study

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