Equiosmolar Solutions of Hypertonic Saline and Mannitol Do Not Impair Blood Coagulation During Elective Intracranial Surgery

Abstract

The use of 5 mL/kg of equiosmolar solutions of 3% HS and 20% mannitol applied to reach a brain relaxation during elective craniotomy does not induce coagulation impairment as evidenced by ROTEM and standard coagulation tests.

Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on whole blood coagulation and platelet function in dogs with suspected intracranial hypertension - a pilot study

“…Similar to the current findings, in two recent studies in people undergoing elective craniotomy or suffering from traumatic brain injury, respectively, no difference in standard coagulation tests and ROTEM® analysis was found between patients administered 20% mannitol and those receiving 3% HTS [ 15 , 28 ].…”

“…In consequence, the safety of using these agents in patients with ICH and intracranial hemorrhage remains unclear [ 4 , 11 , 13 ]. Previous in vitro studies in humans have demonstrated anticoagulant effects of both mannitol and HTS [ 9 , 14 ], although one clinical study failed to demonstrate any negative effect on hemostasis using either solution in patients undergoing elective intracranial surgery [ 15 ]. Similarly, in vitro studies in dogs demonstrated that both mannitol and HTS have negative effects on coagulation in a dose-dependent fashion, although in vivo studies in dogs in a clinical setting are lacking [ 16 , 17 ].…”

Effect of Albumin in Combination With Mannitol on Whole-blood Coagulation In Vitro Assessed by Thromboelastometry

“…However, the authors concluded that, although the administration of hypertonic solutions reduced the levels of platelets and fibrinogen significantly, because of a dilutional effect, it was not enough to reduce MCF. 6 Another clinical study reported that CFT altered significantly from baseline after administration of mannitol alone as well as in combination with hydroxyethyl starch (HES) and MCF measured with FIBTEM did not change from baseline, but differed significantly between groups. 23 Nevertheless, as all ROTEM values remained within normal range, the authors also concluded that mannitol and HES can be safely administered in patients undergoing craniotomy for supratentorial tumors.…”

“…Although mannitol is a solution being infused daily to decrease intracranial pressure and improve surgical conditions during craniotomy, only few studies have evaluated the effect of mannitol on blood coagulation. [1][2][3][4][5][6] In vitro mannitol seems to interfere with blood coagulation by reducing clot strength at 10 and 20 vol% dilutions, 2 which is possibly a result from poor fibrin clot formation. 3 Data from animal studies have also shown that mannitol impairs coagulation in vitro in a dose-dependent manner.…”

“…5 Results from 1 in vivo study, however, indicated that the use of 5 mL/kg of 20% mannitol during elective craniotomy seems to be safe in terms of hemostasis. 6 Although crystalloids remain the first-line choice of maintenance fluid, in severely hypovolemic patients colloids are still often preferred to achieve hemodynamic stabilization faster and in a more volume-efficient way. 7,8 Compared with other colloids, albumin has been thought to have little effect on hemostasis [9][10][11][12][13][14][15] and there are even some data about its hypercoagulational effects at lower hemodilution levels.…”