Is Dilutional Coagulopathy Induced by Different Colloids Reversible by Replacement of Fibrinogen and Factor XIII Concentrates?

Kind, Stephanie L.; Spahn-Nett, Gabriela H.; Emmert, Maximilian Y.; Eismon, Jennifer; Seifert, Burkhardt; Spahn, Donat R.; Theusinger, Oliver M.

doi:10.1213/ane.0b013e3182a52876

Cited by 38 publications

(18 citation statements)

References 39 publications

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“…It seems doubtful whether any conclusions can be drawn from these studies performed mostly under completely different conditions than are present in the acute hypovolaemic trauma patient. In addition to these conflicting results, a recent in vitro study using blood from healthy volunteers demonstrated that coagulation and platelet function are impaired by all HES and gelatin solutions [ 251 ]. However, gelatin-induced coagulopathy was reversible with the administration of fibrinogen, whereas HES-induced coagulopathy was not.…”

Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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BackgroundSevere trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution.MethodsThe pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013.ResultsThe guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome.ConclusionsA multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1265-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

et al. 2016

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“…This might be explained by the fact, that the negative, non-reversible effect of starch on coagulation was postulated during the observed study period. It was shown that colloid solutions are affecting coagulation as well as they are an independent predictor of SIRS and Sepsis in severely injured patients [ 23 – 25 ]. Thereby especially starch worsens blood coagulation by impairing fibrin polymerization and platelet function [ 20 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of two different coagulation algorithms on the use of allogenic blood products and coagulation factors in severely injured trauma patients: a retrospective, multicentre, observational study

Kaserer

Casutt

Sprengel

et al. 2018

Scand J Trauma Resusc Emerg Med

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Background: At the University Hospital Zurich (USZ) and the Cantonal Hospital of Lucerne (LUKS) an individualized goal-directed coagulation and transfusion algorithm was introduced and implemented before 2012 (Coagulation algorithm of the USZ: USZ-Alg; of the LUKS: LUKS-Alg). Main differences between both algorithms are: 1) A target haematocrit-range of 0.21-0.24 (USZ-Alg) vs. a lower haematocrit limit only (LUKS-Alg). 2) Blind coagulation-package in selected cases (LUKS-Alg only). 3) Factor XIII substitution is considered earlier according to the USZ-Alg. The Aim of this study was to analyse the impact of two different coagulation algorithms on the administration of allogeneic blood products, coagulation factors, the frequency of point of care measurements and haemoglobin level during resuscitation in trauma patients. Methods: This retrospective, multicentre, observational study included all adult trauma patients with an injury severity score (ISS) ≥ 16 primarily admitted to the USZ or the LUKS in the period of 2012 to 2014. Referred patients and patients with missing/incomplete records of the initial treatment at the emergency department (ED) were excluded. Two propensity score matched groups were created using a non-parsimonious logistic regression to account for potential differences in patient and trauma epidemiology.

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“…In an earlier study on elective neurosurgery brain tumour resection from our centre, albumin decreased Multiplate aggregation more than HES (Li et al 2015). An in vitro study with extreme colloid dilution (gelatine or HES; 60%) decreased Multiplate aggregation (Kind et al 2013). Neither of these studies measured platelet counts.…”

Section: Discussionmentioning

confidence: 99%

Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery

et al. 2018

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BackgroundHydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.MethodsEighteen patients undergoing major gynaecological surgery were assigned to receive either 5% albumin or 6% dextran-70 with 9 patients in each group. Standard coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and platelet count, viscoelastic coagulation test thromboelastometry (ROTEM) and the Multiplate platelet aggregation test were used to test for coagulation defects at different time points perioperatively. Blood loss, blood loss replacement data and haemodynamic parameters were retrieved from anaesthetic and postoperative charts. A local departmental fluid and transfusion/infusion protocol assured haemoglobin > 90 g/l and mean arterial pressure > 65 mmHg with Ringer’s acetate in addition to the colloid use.ResultsThere were no differences in demographic data between the groups. The tissue factor-activated (EXTEM) clot-structure parameter ROTEM A10 was decreased significantly in the dextran group as compared to the albumin group after the infusion of 500 ml of either colloid solution. The PT and aPTT were significantly prolonged, and the platelet count decreased postoperatively in the dextran group, whereas albumin only deranged fibrinogen levels as compared to preoperative levels. There were no differences in Multiplate platelet aggregometry, amount of haemorrhage or transfusion of blood components between the groups.ConclusionsStandard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran and whether this affects haemostasis to a lesser degree.

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Is Dilutional Coagulopathy Induced by Different Colloids Reversible by Replacement of Fibrinogen and Factor XIII Concentrates?

Abstract: Coagulation and platelet function are impaired by all 3 colloids. However, in vitro gelatin-induced coagulopathy was significantly more reversible than HES-induced coagulopathy.

Cited by 38 publications

References 39 publications

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

The European guideline on management of major bleeding and coagulopathy following trauma: fourth edition

Comparison of two different coagulation algorithms on the use of allogenic blood products and coagulation factors in severely injured trauma patients: a retrospective, multicentre, observational study

Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery

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