Impairment of coagulation by commonly used resuscitation fluids in human volunteers

Abstract

Background: This study compared the effects of two commonly used resuscitation fluids on whole blood coagulation. Methods: 1000 ml of two resuscitation fluids each (saline and Gelofusine) were given to eight volunteers in a crossover design with a 2-week washout period. The effect on whole blood coagulation was assessed using the Sonoclot analyzer, a conventional coagulation screen and coagulation markers. Results: No significant effect was found on whole blood coagulation by giving saline (time to peak clot increased by a mean of 106 s; (95% confidence interval (CI) -140 to 354), whereas Gelofusine delayed the time to peak by a mean of 845 s (95% CI 435 to 1255). By contrast, there was no change in the conventional coagulation screen with either fluid. Conclusion: It was concluded that some resuscitation fluids have an effect on clot formation that is not shown by the conventional coagulation screen, but is disclosed only if the whole coagulation process is studied.

Administration of fibrinogen concentrate in exsanguinating trauma patients is associated with improved survival at 6 hours but not at discharge

“…27,28 As an additional iatrogenic factor, resuscitative fluidsV particularly colloidsVhave been demonstrated to compromise fibrin polymerization. 29 Considering these mechanisms, the importance of fibrinogen replacement in exsanguinating trauma is recognized widely and FC is used routinely in European trauma centers. Whereas the critical trigger for fibrinogen substitution used to be at plasma concentrations approximately 1 g/L, 30 the current European guidelines for management of bleeding following major trauma recommend an increased threshold level of 1.5 g/L to 2 g/L despite very limited evidence.…”

Acute Coagulopathy in Isolated Blunt Traumatic Brain Injury

“…Hypotension has recently been identified as another principle driver of coagulopathy possibly via the activation of the protein-C-pathway [28,37]. On the other hand, concerns are raised that aggressive fluid resuscitation can lead to hemodilution including dilution of coagulation factors, subsequently exacerbating hemostatic disorders [28,33,36,38].…”

Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1987 patients

“…The dilution of coagulation factors due to fluid administration has been shown to be a major cause of clinical coagulopathy in trauma 8 24 25. Even though initial intravenous fluids remain an important component to promote oxygen delivery and tissue perfusion, the traditional approach of immediate intravenous therapy with 2 l isotonic crystalloids may exacerbate coagulopathy, not only through further haemodilution but also by disturbance of the electrolyte balance.…”

“…As colloids lead to a higher dilution of the plasma volume than crystalloids, dilution of existing coagulation factors may be potentiated 24. In addition, colloidal fluids have been shown directly to impair platelets and reduce clot stability 25 28. However, further prospective clinical trials are necessary to guide the choice of resuscitative fluids during prehospital and early in-hospital treatment of severely injured patients.…”