Hemostatic Changes After Crystalloid or Colloid Fluid Administration During Major Orthopedic Surgery: The Role of Fibrinogen Administration

Abstract

Disturbance of fibrinogen/fibrin polymerization is the primary problem triggering dilutional coagulopathy during major orthopedic surgery. The magnitude of clot firmness reduction is determined by the type of fluid used, with hydroxyethyl starch showing the most pronounced effects. These undesirable effects of intravascular volume therapy can be reversed by increasing fibrinogen concentration by administering fibrinogen concentrate, even during continuing blood loss and intravascular volume replacement.

The Effect of Crystalloid vs. Crystalloid plus Colloid Infusion on the Coagulation System in Patients Undergoing Cancer Breast Surgery

“…PT and aPTT tests are usually used to detect coagulation factor deficiencies and the need for FFP transfusion, previous results found that these coagulation tests become pathological soon, although no critical reduction in coagulation factor was present [13]. Our findings that changes in PT were comparable between both groups come in accordance with other studies [10], whereas aPTT and fibrinogen were significantly more impaired with crystalloid plus colloid infusion as compared with crystalloid.…”

“…In addition, when blood is diluted with an intravenous fluid the hemodilution effect can itself alter hemostatic mechanism [12]. Patients undergoing extensive prolonged surgery are prone to develop coagulopathy, even when there is no preoperative coagulopathy or dysfunction of primary hemostasis [13]. This called dilution coagulopathy which results from blood loss, consumption of coagulation factors and platelets, and intravascular volume replacement.…”

“…This called dilution coagulopathy which results from blood loss, consumption of coagulation factors and platelets, and intravascular volume replacement. In vivo and in vitro hemodilution coagulation studies in normal individuals are therefore an important source of information regarding the effect on hemostasis of intravenous fluid resuscitation [12], their results have clearly demonstrated that natural and artificial colloids impair hemostasis more than crystalloids do [13].…”

“…Mittermayr et al [13] found that colloid influence the speed and quality of clot formation by interfering with fibrinogen concentration and functional measured fibrinogen/fibrin polymerization.…”

Clinical review: Prothrombin complex concentrates - evaluation of safety and thrombogenicity

“…Conventional coagulation tests such as the prothrombin time are not affected by levels of coagulation inhibitors such as protein C; the International Normalised Ratio may therefore not be a true reflection of the haemostatic state of a patient [31]. During volume replacement of blood loss, particularly with colloids, conventional prothrombin time and activated partial thromboplastin time assays may suggest critical reduction in coagulation factors, whereas the coagulation time measured in whole blood using thromboelastography may remain within the normal range [51]. Theoretically, thrombin generation measurement should be preferable for guiding PCC administration and monitoring its efficacy.…”