Differential effects of serial hemodilution with hydroxyethyl starch, albumin, and 0.9% saline on whole blood coagulation

Tobias, M; Wambold, Daniel; Pilla, Michael A.; Greer, Florencia

doi:10.1016/s0952-8180(98)00034-8

Cited by 67 publications

(45 citation statements)

References 27 publications

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“…Admittedly, it was an in vitro study, and plasma was used rather than whole blood. Tobias et al performed a serial haemodilution study, using saline, 5% albumin and a hetastarch [13]. They showed that a hypercoagulable trend developed at mild to moderate haemodilution, even in the colloid groups.…”

Section: ó 2002 Blackwell Publishing Ltdmentioning

confidence: 99%

Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline‐based hetastarch solution and lactated Ringer's solution*

et al. 2002

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SummaryThe hydroxyethyl starches are a group of compounds that has been associated with impairment of coagulation when large volumes are administered. The thrombelastographÒ is commonly used to assess point-of-care whole blood coagulation. Little is known about the dose-response relationships of haemodilution, and it is reasonable to assume that a linear association exists. This may not be the case with altered electrolyte compositions of the fluids used for haemodilution. We have therefore conducted an in vitro study of haemodilution of human whole blood using lactated Ringer's solution and two high molecular weight hetastarches, one in a balanced salt solution, the other in a 0.9% saline solution. The thrombelastographÒ, commonly used for the assessment of the coagulation effects of synthetic colloids, was used as the coagulation assessment device. Serial haemodilution with hetastarch in a balanced salt solution demonstrated a biphasic response (of r-times and k-times, as well as alpha angles), with haemodilution in the 20-40% range causing enhanced coagulation, and higher degrees of dilution causing a decrease in overall coagulation performance. A similar picture was observed with lactated Ringer's solution, but only significantly so in alpha angles. Hetastarch in saline did not display this initial increased coagulability at mild to moderate dilutions. This biphasic response of lactated Ringer's solution and hetastarch in a balanced salt solution reflects the complex interaction of fluids and the coagulation system, and that these effects cannot be attributed to simple haemodilution. On the other hand, there was a linear decrease in maximum amplitude with haemodilution. Maximum amplitude was particularly affected by both starches, which is an expected finding in view of the known interaction between the hydroxyethyl starches and von Willebrand's factor.

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Section: ó 2002 Blackwell Publishing Ltdmentioning

confidence: 99%

Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline‐based hetastarch solution and lactated Ringer's solution*

et al. 2002

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“…Tobias et al [21] found that albumin may also lead to hypocoagulability. Dietrich et al showed an in vitro increase in bleeding time [22], which may increase blood loss in post-surgical or trauma patients.…”

Section: Coagulation and Homeostasismentioning

confidence: 99%

How to Maintain and Restore Fluid Balance: Colloids

Fries¹,

Benedetto

2013

Body Fluid Management

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“…Furthermore, HA may impact coagulation and hemostasis by enhancing antithrombin III activity and inhibiting platelet function Rajnish et al 2004). Tobias et al (1998) found that albumin may also lead to hypocoagulability. Dietrich et al (1990) showed an in vitro increase in bleeding time, which may increase blood loss in postsurgical patients.…”

Section: Potential Risks and Side Effectsmentioning

confidence: 99%