Comparison of Hypertonic Saline and Mannitol on Whole Blood Coagulation In Vitro Assessed by Thromboelastometry

Luostarinen, Teemu; Niiya, Tomohisa; Schramko, Alexey; Rosenberg, P. H.; Niemi, Tomi

doi:10.1007/s12028-010-9475-6

Cited by 33 publications

(28 citation statements)

References 24 publications

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“…Similar to our study, Luostarinen et al (1) showed that HS is more problematic than mannitol with respect to coagulation. This study also showed that the use of 3% HS could be a better choice in patients with abnormal bleeding tendency and/or patients who are under a high risk of bleeding surgery.…”

Section: Discussionsupporting

confidence: 92%

“…Additionally, adding HES to this fluid severely increased the negative impact on the extrinsic coagulation pathway by increasing hemodilution. In previous studies, no InTEM analysis has been performed but data gained using ExTEM analysis were similar to that in the present study (1,6,13). We found disruption of platelet function only when mannitol or HS was combined with HES solution.…”

Section: Discussionsupporting

confidence: 88%

“…annitol and hypertonic saline (HS) are commonly used to reduce brain oedema and intracranial pressure and to minimise brain volume in neurosurgical practise (1). Mannitol is recommended as a first-choice hyperosmotic agent (2).…”

mentioning

confidence: 99%

“…In the literature, only one study has compared the effect of mannitol and HS on coagulation (1). Luostarinen et al (1) investigated the effects of both fluids at doses higher than used intraoperatively and did not consider the effects of colloid addition. In cranial surgeries, mannitol 1 gr kg -1 (or less) and equivalent HS is used as an anti-oedematous therapy.…”

mentioning

confidence: 99%

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A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

Ali¹,

Sencan²,

Sabancı³

et al. 2017

Turk J Anaesth Reanim

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Objective:The aim of the present study is to compare the effect of 20% mannitol and 3% NaCl on blood coagulation in vitro using rotational thromboelastometry (ROTEM). Methods:Twenty-millilitre blood samples were obtained from 15 volunteers. In each group, 2 mL blood samples were collected into both polypropylene tubes and EDTA tubes for ROTEM and hemogram analysis. After sampling, blood samples were diluted with test solutions. Group C (control): Only blood, Group M (mannitol): 7% vol 20% mannitol concentration in the blood, Group hypertonic saline (HS): 7% vol 3% hypertonic saline (NaCl) in the blood, Group M/H (mannitol and hydroxyethyl starch solutions [HES]): 6% vol 20% mannitol concentration and 8% vol HES in the blood and Group HS/H (hypertonic saline and HES): 6% vol 3% hypertonic saline concentration and 8% vol HES in the blood. The following thromboelastometric parameters were measured automatically: clotting time (CT) and clot formation time (CFT) with intrinsic activation by tissue factor (InTEM), CT, CFT and maximum clot firmness (MCF) with extrinsic activation by tissue factor (ExTEM) and MCF with FibTEM. Results:The ExTEM CT value was found to be significantly longer in the M/H group than in the controls. The ExTEM CFT median and percentile values were: group C: 85 s (70-95 s), group M: 115 s (94-128 s), group HS: 102 s (84-114 s), group M/H: 128 s (110-144 s) and group HS/H: 118 s (107-132 s). In all the groups, FibTEM MCF values were significantly lower than the control and also there was a significant difference between groups M and HS according to FibTEM MCF values. Conclusion:Whole-blood coagulation disorder induced by these solutions is mainly dependent on fibrinogen and fibrin interaction. However, 3% HS has much less negative effect on coagulation.Keywords: 20% mannitol, 3% NaCl, coagulation, neuroanaesthesia Amaç: Bu çalışmada %20 Manitol ve %3 NaCl'nin in vitro ortamda koagülasyon üzerine etkilerini karşılaştırmayı amaç-ladık.Yöntemler: On beş gönüllünün her birinden 20 mL kan örne-ği alındı. Her grupta rotasyonel tromboelastometri (ROTEM) ve hemogram analizi için 2'şer mL kan örneği polipropilen ve EDTA tüplerinde toplandı. Örnekleme sonrası kan örnekleri test solüsyonları ile seyreltildi. Grup K (Kontrol): sadece kan, Grup M (Mannitol): Kan içinde %7 konsantrasyonda %20 mannitol, Grup hipertonik salin (HS): Kan içinde %7 konsantrasyonda %3 hipertonik salin, Grup M/H (Mannitol ve HES): Kan içinde %7 konsantrasyonda %20 mannitol ve %8 konsantrasyonda HES, Grup HS/H (Hipertonik Salin ve HES): Kan içinde %7 konsantrasyonda %3 hiperetonik salin ve %8 konsantrasyonda HES. Bu işlem sonrası İnTEM'de pıhtılaşma zamanı (PT) ve pıhtı oluşumu zamanı (CFT), ExTEM'de CT, CFT ve maksimum pıhtılaşma zamanı ve FibTEM'de MCF den oluşan thromboelastometri parametreleri otomatik olarak ölçüldü. Bulgular: ExTEM CT değerleri kontrol grubuna göre M/H grubunda önemli ölçüde daha yüksek bulundu. ExTEM CFT medyan ve persentil değerleri şöyledir: C grubu 85S (70-95s), M grubu 115s (94-128s), HS grubu 102S (84-114...

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 99%

mentioning

confidence: 99%

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A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

Ali¹,

Sencan²,

Sabancı³

et al. 2017

Turk J Anaesth Reanim

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“…In both cases, induced disorders are mainly dependent on fibrinogen-fibrin interactions as demonstrated by ROTEM®. The results are consistent with those of previously published studies (12)(13)(14), although the new contribution is the combination of both osmotic solutions with starch currently used in current practice.…”

supporting

confidence: 92%

The Complex Process of Haemostasis and Interactions due to Hyperosmotic Fluids

Granell¹,

Llau²

2017

Turk J Anaesth Reanim

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N atural haemostasis includes a variety of physiological events by which bleeding stops in case of vascular injury. Haemostasis is a complex process that involves several steps to achieve the final objective of haemorrhage cessation. Classically, the first step is the constriction of injured blood vessels to decrease local blood flow, leading to platelet adhesion and aggregation, which are referred to as 'primary haemostasis'. Afterwards, the process of fibrin formation and stabilisation begins, referred to as 'secondary haemostasis', which involves many intermediate enzymatic reactions with coagulation factors. These steps have a feedback restricting haemostasis to prevent thrombotic events through the activation of the fibrinolytic system that allows the beginning of the repair of the vascular and tissue defect (1).This course of haemostatic events has been explained by developing theories to elucidate all interactions between platelets, coagulation factors via the waterfall model, cofactors without enzymatic activity, antithrombotic mechanisms, and so on. In previous years, the cell-based model of haemostasis, in which the endothelium has a central role, has been accepted because of its best explanation of haemostasis. In this model, which was first proposed in 2001 (2), three overlapping phases can be differentiated. In the initiation phase, which is the first phase, coagulation starts when the vasculature is injured and subendothelial cells expose tissue factor (TF), which is the key initiator of haemostasis, that binds to coagulation factor VII, leading to its activation to FVIIa. The TF/FVIIa complex begins the activation of other coagulation factors, with the final objective of the formation of small amounts of thrombin (3). In the amplification phase, which is the second phase, thrombin activates platelets that have adhered to the site of injury and several coagulation factors. They bind to thrombogenic platelet surfaces and intensify and amplify prothrombinase activity (4). In the third phase (propagation phase) activated factors on catalytic platelet surfaces activate prothrombin (factor II) resulting in a massive generation of thrombin (factor IIa). The generated 'thrombin burst' converts fibrinogen into fibrin to form a sufficiently large clot. In the final step, thrombin-activated factor XIII (FXIIIa) catalyses the formation of crosslinks between fibrin fibres to form an elastic and stable fibrin clot (5).This 'perfect system' is disrupted in current clinical practice by the administration of several drugs. The most commonly known are antiplatelet and anticoagulant agents, but some others can also disturb coagulation. For example, if the infusion of large amounts of fluids is needed to restore intravascular volume and maintain tissue perfusion when an important blood loss occurs, a nonspecific coagulopathy due to the dilution of coagulation factors and platelets could impair the coagulation. It is related to the amount of infused fluid rather than to its type.Nevertheless, in addition to this dilut...

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Trauma Overview

Reineke

2018

Textbook of Small Animal Emergency Medicine

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Comparison of Hypertonic Saline and Mannitol on Whole Blood Coagulation In Vitro Assessed by Thromboelastometry

Cited by 33 publications

References 24 publications

A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

The Complex Process of Haemostasis and Interactions due to Hyperosmotic Fluids

Trauma Overview

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