Effects of in vitro hemodilution with crystalloids, colloids, and plasma on canine whole blood coagulation as determined by kaolin‐activated thromboelastography

Morris, Bari; deLaforcade, Armelle M.; Lee, Joyce; Palmisano, Joseph; Meola, Dawn M.; Rozanski, Elizabeth A.

doi:10.1111/vec.12345

Cited by 20 publications

(23 citation statements)

References 25 publications

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“…However, some synthetic colloids have been associated with hypocoagulability, which may increase risk of bleeding in a patient already experiencing perturbed hemostasis. In dogs, studies including in vitro ( 13 – 17 ), in vivo healthy dog ( 18 , 19 ), and experimental sepsis ( 20 ) designs have shown an association between HES and both decreased platelet function and hypocoagulability. Only one study has compared the effects of low molecular weight (MW) HES with isotonic crystalloid under the conditions of atraumatic hemorrhagic shock ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

et al. 2018

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Background: Hemorrhagic shock and volume replacement can alter coagulation. Synthetic colloids, hydroxyethyl starch (HES), and gelatin, may enhance hypocoagulability. Our primary objective was to describe the effect of four fluid products on coagulation in canine hemorrhagic shock. Our secondary objective was to compare measurements of coagulation during shock to baseline in all dogs.Methods: Anesthetized greyhounds subjected to atraumatic hemorrhage for 60 min were administered 20 mL kg−1 of either fresh whole blood (FWB), 6% HES 130/0.4, 4% succinylated gelatin (GELO), or 80 mL kg−1 of isotonic crystalloid over 20 min (n = 6 per group). Platelet closure time (PCT), rotational thromboelastometry (ROTEM) and plasma coagulation assays were measured at baseline, end of hemorrhage (shock), and 40 (T60), and 160 (T180) min after study fluid. ROTEM parameters included clotting time (CT), clot formation time (CFT), alpha angle, maximum clot firmness (MCF), lysis index at 60 min (LI60), and thrombodynamic potential index (TPI) for INTEM, EXTEM, FIBTEM (MCF only), and APTEM (LI60 only) profiles. Plasma coagulation assays included prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen concentration and activities of factor VII (FVII), factor VIII (FVIII), and von Willebrand Factor antigen (vWF). Between-group differences were tested using linear mixed models with post-hoc between-group comparisons (Bonferroni-Holm corrected). Differences between baseline and shock were tested using paired t-tests. Significance was set at P < 0.05.Results: GELO showed longer PCT at T60, compared with FWB and CRYST, and at T180, compared with all other groups. HES showed longer EXTEM CT at T60, compared with all other groups. HES showed lower INTEM and EXTEM MCF at T60 and lower INTEM MCF at T180, compared with FWB. Some plasma coagulation assays showed greater hypocoagulability with HES. Comparing shock to baseline, EXTEM CT, INTEM CFT, EXTEM CFT, PT, and FVIII significantly increased and PCT, INTEM CT, INTEM MCF, EXTEM MCF, EXTEM LI60, EXTEM TPI, FIBTEM MCF, APTT, fibrinogen, FVII, and vWF significantly decreased.Conclusions: In dogs with hemorrhagic shock, volume replacement with GELO caused mild platelet dysfunction and HES was associated with coagulation changes consistent with hypocoagulability, beyond effects of hemodilution. Shock alone produced some evidence of hypocoagulability.

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Section: Introductionmentioning

confidence: 99%

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

et al. 2018

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“…Dilutional coagulopathy occurs most frequently in cases requiring significant fluid resuscitation, often incorporating crystalloids, synthetic colloids, or packed red blood cells . The most common hemostatic changes include thrombocytopenia, prolongation of both PT and aPTT, and hypofibrinogenemia .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous hemoperitoneum and anaphylactic shock associated with Hymenoptera envenomation in a dog

Caldwell

Petras

Mattison

et al. 2018

J Vet Emergen Crit Care

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“…, Morris et al . ). Fluid therapy should be continued until traditional end‐points of resuscitation are achieved, including normalisation of heart rate, arterial blood pressure and urine output.…”

Section: Therapeutic Targetsmentioning

confidence: 99%

“…Synthetic colloid use contributes to coagulopathy through decreased levels of von Willebrand factor (vWF) and Factor VIII (fVIII) and decreased expression/activation of platelet integrin α IIb β 3 (Smart et al . 2009, Morris et al . 2016.…”

Section: Fluid Therapymentioning

confidence: 99%

Bacterial translocation in critical illness

Krentz¹,

Allen²

2017

J of Small Animal Practice

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Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.

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Effects of in vitro hemodilution with crystalloids, colloids, and plasma on canine whole blood coagulation as determined by kaolin‐activated thromboelastography

Abstract: In vitro hemodilution of whole blood with both LRS and HES but not FFP resulted in significant effects on coagulation with HES having a more profound effect. In vivo evaluation of changes in coagulation with various resuscitation fluids is warranted and may be clinically relevant.

Cited by 20 publications

References 25 publications

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

Hypocoagulability and Platelet Dysfunction Are Exacerbated by Synthetic Colloids in a Canine Hemorrhagic Shock Model

Spontaneous hemoperitoneum and anaphylactic shock associated with Hymenoptera envenomation in a dog

Bacterial translocation in critical illness

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