Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer’s vs. Dextran - a randomized controlled trial

Abstract

BackgroundPerioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.MethodsForty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer’s solution or Dextran 70 (Macrodex ®) that affects coagulation competence.ResultsBy thrombelastography evaluated coagulation competence, Dextran 70 reduced “maximal amplitude” (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer’s solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer’s group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = −0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer’s group (P = 0.04).ConclusionsWith the use of Dextran 70 vs. lactated Ringer’s solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.Trial registrationThe study was accepted on January 7th, 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20.

The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial

“…However, we found no significant differences in bleeding or transfusion requirements between our two groups. Two randomised controlled trials in which dextrans were compared with crystalloids found no differences in bleeding . Additionally, the use of 6% HES 130/0.4 as a pump prime volume of 20 ml.kg −1 or 30 ml.kg −1 per day did not increase peri‐operative blood loss in adults undergoing cardiac surgery .…”

Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis—a single‐center experience of patient blood management in 210 cases

“…PBM transfusion strategies include predonated autologous RBCs, the use of intraoperative cell salvage, restrictive triggers for use of allogeneic RBCs, and the use of viscoelastic hemostatic assays to guide a restrictive use of plasma, platelets, and goal‐directed, prohemostatic therapy . PBM strategies to reduce intraoperative blood loss incorporate the use of permissive hypotension during bleeding, the limited use of fluids to avoid dilution coagulopathy, the avoidance of synthetic colloids, and the use of tranexamic acid . Another pillar of PBM is the preoperative identification of patients who are at risk of receiving perioperative blood transfusion.…”

Choice of fluid type: physiological concepts and perioperative indications

“…48 However, the same authors could not repeat these findings in two comparative studies in a similar population when comparing Dextran 70 or albumin 5% with Ringer's lactate. 49,50 In conclusion, the majority of studies do not show a difference in blood loss between fluid types. These data should be viewed in light of different dosing strategies and populations amongst studies.…”

“…Artificial colloids (HES and dextrans) were compared to crystalloids (both balanced and unbalanced) in seven of the selected studies. 26,27,30,48,49,106,107 In two studies, blood loss was increased in the HES group compared to the crystalloid group, albeit that blood loss was only a primary end point in the cystectomy study. 26,48 The use of dextrans was associated with more major blood loss (>1500 ml) compared to Ringer's lactate.…”