Prospective double-blind randomized study of the effects of four intravenous fluids on platelet function and hemostasis in elective hip surgery

Abstract

Summary.A prospective randomized double-blind study was performed to determine the effects of three colloids, Haemaccel, Gelofusine and albumin, and also saline on platelet activation, platelet aggregation (induced by adenosine diphosphate (ADP), epinephrine, collagen) platelet agglutination by ristocetin and other hemostatic variables in 55 patients undergoing primary unilateral total hip replacement. The¯uids were administered according to normal clinical practice and assessments were made immediately before, at the end, and 2 h after the end of surgery. Surgery was accompanied by thrombin generation (increases in thrombin/antithrombin III complex, prothrombin F1 2 fragment) platelet activation (bTG) and compromised coagulation. Generally, the platelet activation appeared to result in platelet desensitization and brought about a persistent reduction in platelet aggregation to ADP and epinephrine, irrespective of the¯uid used. Additionally, Haemaccel and Gelofusine inhibited ristocetin-induced platelet agglutination and albumin inhibited collagen-induced platelet aggregation. Gross inhibitory effects of Haemaccel that had been predicted from an earlier in vitro study did not occur. Particular¯uids had selective additional effects on the hemostatic system. Albumin infusion served to maintain plasma albumin at normal concentrations postsurgery. The two gelatin preparations, Haemaccel and Gelofusine, maintained plasma viscosity. All three colloids led to a transient increase in activated partial thromboplastin time postsurgery and also a transient fall in the concentration of factor VIII, which were accompanied by a transient increase in bleeding time, but there was no measurable increase in blood loss. Inhibition of platelet aggregation by certain colloids may provide additional protection against the increased thrombotic risk in patients following major surgery.

The effects of commonly used resuscitation fluids on whole blood coagulation

“…A previous research letter has reported inhibition of ristocetin induced platelet aggregation by Haemaccel, 47 and in patients undergoing elective orthopaedic surgery, platelet aggregation seems to be inhibited by both Haemaccel and Gelofusine. 48 We do not yet know if the effects found are important in patients. It was particularly interesting that there was little change in the Sonoclot ACT (which measures the same aspects of coagulation as the conventional coagulation screen, the international normalised ratio and activated partial thromboplastin time), but there was a large change in TTP (which is not measured in the conventional coagulation screen).…”

Effects of albumin 5% and artificial colloids on clot formation in small infants

“…In patients undergoing hip replacement Evans et al. [6] found that platelet aggregation decreased similarly for albumin and two different gelatine solutions. In addition, aPTT increased and concentrations of coagulation factor VIII transiently decreased, but blood loss was comparable in all groups.…”

Safety of gelatin for volume resuscitation—a systematic review and meta-analysis

“…2. Three studies had a a low risk of bias in all domains [19][20][21], and five studies had a low risk in all domains except blinding [22][23][24][25][26]. (Table 1).…”