Effects of acidosis, alkalosis, hyperthermia and hypothermia on haemostasis: results of point of care testing with the thromboelastography analyser

Ramaker, Albert J. D. W. R.; Meyer, Peter; Meer, Jan van der; Struys, Michel; Lisman, Ton; Oeveren, Wim van; Hendriks, Herman G. D.

doi:10.1097/mbc.0b013e32832dc327

Cited by 49 publications

(36 citation statements)

References 14 publications

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“…When coagulation is assessed using thromboelastometry or thromboelastography, hypothermia prolongs the coagulation time and clot formation time in whole blood. [8][9][10] In animal models, platelet counts fall significantly during deep hypothermia. This is believed to be due to a reversible sequestration of platelets in the liver.…”

Section: Introductionmentioning

confidence: 99%

Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

Mazzeffi¹,

Marotta²,

Lin³

et al. 2012

Ann Card Anaesth

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Deep hypothermia, which is used during thoracic aortic surgery for neuroprotection, is associated with coagulation abnormalities in animal and in vitro models. However, there is a paucity of data regarding the impact of deep hypothermia duration on perioperative bleeding. The objective of the current study was to examine the relationship between the duration of deep hypothermia and perioperative bleeding. A retrospective review of 507 consecutive thoracic aortic surgery patients who had surgery with deep hypothermic circulatory arrest was performed. The degree of bleeding and coagulopathy was estimated using perioperative transfusion. Log linear modeling with Poisson regression was used to analyze the relationship between deep hypothermia duration and perioperative bleeding, while controlling for other preselected variables. There was a significant association between deep hypothermia duration and RBC transfusion (P = 0.001). There was no significant association between deep hypothermia duration and FFP and platelet transfusion (P = 0.18 and P = 0.06). The association between deep hypothermia duration and the amount of bleeding (RBC transfusion) was dependent on total CPB time. In general, for shorter CPB times (approximately 120 to 180 minutes) there was an upward sloping line or positive relationship between deep hypothermia duration and bleeding. However, for cases with longer CPB times (300 to 360 minutes), there was no such relationship. The relationship between deep hypothermia duration and perioperative bleeding is dependent on CPB time. For surgeries with short CPB times (120 to 180 minutes), prolonged deep hypothermia is associated with increased post-operative bleeding, as estimated by RBC transfusion. For cases with longer CPB times (300 to 360 minutes), there appears to be no relationship.

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Section: Introductionmentioning

confidence: 99%

Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

Mazzeffi¹,

Marotta²,

Lin³

et al. 2012

Ann Card Anaesth

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“…12 Other studies focused solely on pH-induced coagulation alteration. 13,14 However, no attempts have combined both study of acidemia and blood components to fully evaluate the possible contributions to ATC, particularly as measured by TEG.…”

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confidence: 99%

Acute traumatic coagulopathy

Campbell

Aden

Andreas

2015

Journal of Trauma and Acute Care Surgery

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Acidemia-induced coagulopathy at the level of the capillary Hct (1) is more severe than at higher Hct levels (larger blood vessels), (2) shows that simulated resuscitation with NS causes greater increases in clot time and decreases in clot strength beyond that which occurs with plasma replacement, and (3) may not accurately be portrayed through common TEG practice of testing systemic WB of greater than 30% Hct.

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Section: Discussionmentioning

confidence: 99%

“…Hypothermia and acidosis are common complications in severely injured patients [1,2]. The negative impact of these conditions on coagulation resulting in coagulopathy has been well described [3][4][5][6][7][8][9].Desmopressin is a synthetic analogue of vasopressin (1-deamino-8-D-aginine vasopressin, DDAVP). Beside its first indication for treatment of cranial diabetes insipidus, it has become the treatment of choice for von Willebrand disease (Type I) and mild haemophilia A after it was shown that DDAVP leads to increased levels of coagulation factor (F) VIII, von Willebrand factor (vWF), and tissue plasminogen activator [10].…”

mentioning

confidence: 99%

Effects of desmopressin on platelet function under conditions of hypothermia and acidosis: an in vitro study using multiple electrode aggregometry*

Hanke

Dellweg²,

Kienbaum

et al. 2010

Anaesthesia

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SummaryHypothermia and acidosis lead to an impairment of coagulation. It has been demonstrated that desmopressin improves platelet function under hypothermia. We tested platelet function ex vivo during hypothermia and acidosis. Blood samples were taken from 12 healthy subjects and assigned as follows: normal pH, pH 7.2, and pH 7.0, each with and without incubation with desmopressin. Platelet aggregation was assessed by multiple electrode aggregometry. Baseline was normal pH and 36°C. The other samples were incubated for 30 min and measured at 32°C. Acidosis significantly impaired aggregation. Desmopressin significantly increased aggregability during hypothermia and acidosis regardless of pH, but did not return it to normal values at low pH. During acidosis and hypothermia, acidosis should be corrected first; desmopressin can then be administered to improve platelet function as a bridge until normothermia can be achieved. Hypothermia and acidosis are common complications in severely injured patients [1,2]. The negative impact of these conditions on coagulation resulting in coagulopathy has been well described [3][4][5][6][7][8][9].Desmopressin is a synthetic analogue of vasopressin (1-deamino-8-D-aginine vasopressin, DDAVP). Beside its first indication for treatment of cranial diabetes insipidus, it has become the treatment of choice for von Willebrand disease (Type I) and mild haemophilia A after it was shown that DDAVP leads to increased levels of coagulation factor (F) VIII, von Willebrand factor (vWF), and tissue plasminogen activator [10]. It also has been shown to improve platelet function [11][12][13] even under anti-platelet drug therapy [14] or after cardiopulmonary bypass [15]. DDAVP has been shown to correct hypothermia-induced impairment of primary haemostasis partially [16]. The effect of DDAVP under hypothermia and acidosis has not been evaluated to date. Thus, we tested the hypothesis that DDAVP is able to improve platelet function under both hypothermia and acidosis. Anaesthesia, 2010Anaesthesia, , 65, pages 688-691 doi:10.1111Anaesthesia, /j.1365Anaesthesia, -2044Anaesthesia, .2010 Twelve healthy volunteers of Caucasian origin participated in the study after oral and written information and written consent. All volunteers were healthy and with no history of abnormal bleeding nor taking coagulation impairing drugs. Blood was drawn into four 4.5-ml tubes containing 20 lg.ml )1 recombinant hirudin (Dynabyte, Munich, Germany) from a basilic vein using a 18-G cannula. Seven polypropylene tubes were labelled (Tube 1-7) and the collected hirudinised blood was immediately aliquoted into these tubes in 2.7-ml split samples. The test group (DDAVP+) was defined as samples treated with DDAVP. These samples were prepared yielding a final concentration of 1 nM representing an approximate plasma concentration after recommended treatment with DDAVP of 0.3 lg.kg )1 [17]. Samples without treatment with DDAVP were assigned to the control group (DDAVP)). Baseline was defined as a sample without DDAVP treatment ...

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Effects of acidosis, alkalosis, hyperthermia and hypothermia on haemostasis: results of point of care testing with the thromboelastography analyser

Cited by 49 publications

References 14 publications

Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion

Acute traumatic coagulopathy

Effects of desmopressin on platelet function under conditions of hypothermia and acidosis: an in vitro study using multiple electrode aggregometry*

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