Evaluation of hemostatic changes using thromboelastography after crystalloid or colloid fluid administration during major orthopedic surgery

Abstract

The effects of Ringer lactate, 6% hydroxyethyl starch (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% hydroxyethyl starch 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.

Effect of perioperative crystalloid or colloid fluid therapy on hemorrhage, coagulation competence, and outcome

“…The perioperative changes in coagulation competence were measured by TEG-MA in 9 studies administering crystalloids versus HES [ 22 , 28 , 29 , 31 , 36 – 38 , 40 , 41 ] (Fig. 2 ) and in 4 studies administering albumin versus HES (Fig.…”

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

“…Another advantage of these apparatuses, with the tests being performed on whole blood, is the capability to simultaneously study the interactions between platelets, cells and coagulation factors. Only a few studies have evaluated the use of thromboelastometry/graphy in patients undergoing MEOS [9][10][11][12][13][14][15]. However, none of them evaluated the determinants of significant bleeding.…”

“…However, none of them evaluated the determinants of significant bleeding. Moreover, most of these studies took into account only selected aspects of this matter (e.g., the role of fluid administration [11,13] or the effect of anticoagulant prophylaxis [15] on the whole blood coagulative profile), while only one study evaluated at the same time the thromboelastography and thrombin generation profile [15]; and finally, no study focused on bleeding patients. The aims of our study were: (a) to evaluate the dynamics of the coagulation profile in patients undergoing MEOS, both with traditional tests (e.g., platelet count, prothrombin and activated partial thromboplastin time) and specific global tests (e.g., whole blood thromboelastography profiles by the ROTEM Ò delta apparatus and plasma thrombin generation by calibrated automated thrombogram-CAT); (b) to allow an early diagnosis of perioperative coagulopathy developed by patients experiencing major intraoperative bleeding.…”

Preoperative FIBTEM Predicts Postoperative Hemorrhage in Total Knee Arthroplasty

“…Intraoperative fluid administration and the consumption of coagulation factors and platelets with intraoperative blood loss can lead to differences between preoperative and postanesthetic coagulation status. [18][19][20] Conventional coagulation laboratory parameters PT-INR and aPTT were not useful for predicting postoperative hemorrhage and could not provide information to devise a transfusion plan for the patients. There were limitations of this study.…”