The Development of Hypercoagulability State, as Measured by Thrombelastography, Associated with Intraoperative Surgical Blood Loss

Abstract

Thrombelastographic evidence of hypercoagulability, including shortening of r-time (P< 0.01); shortening of k-time (P<0.01); and widening of trace angle (P<0.01) were observed in a group of 21 Chinese surgical patients when (a) the amount of blood loss was at an estimated 10% of total blood volume and (b) the amount of blood loss was at an estimated 15% of blood volume. The amount of blood loss was documented by haemoglobin measurements. No evidence of hypercoagulability was observed at around one hour into the operation in the absence of bleeding. We conclude that a mild to moderate degree of surgical blood loss with haemodilution is associated with the development of hypercoagulability as measured by thrombelastography. Further studies looking at the thrombebolic outcome in such groups of patients is warranted. It is also suggested that caution should be exercuised in the use of intraoperative isovolaemic haemoldilution until the phenomenon is further investigated.

The effect of ulinastatin on hemostasis in major orthopedic surgery

“…The exposed bony surfaces are not amenable to standard hemostatic maneuvers used during soft tissue surgery, which contributes to perioperative hemorrhage and activates coagulation and the fibrinolytic cascade [2,3]. Surgical manipulation and associated tissue trauma also contribute to the activation of tissue factors and the systemic inflammatory response [4]. The inflammatory process promotes the release of serine protease by neutrophils, macrophages, lymphocytes, and endothelial cells.…”

Nicardipine versus nitroprusside for deliberate hypotension during idiopathic scoliosis repair

“…However, our baseline blood draw may have been contaminated by the induction dose of thiopental, which has been demonstrated to inhibit platelet aggregation. 19,20 Subsequent blood draws at times 2, 3, and 4 may also have demonstrated the hypercoaguable effects of crystalloid dilution 21,22 and surgery. 23,24 In addition, thrombin generation in association with surgery has been shown previously, 25 and it could act synergistically with the added reagents.…”

Critically Ill Cancer Patients are not Consistently Hypercoagulable after Craniotomy

“…R indicates the time from the moment the sample starts to be tested until the beginning of fibrin formation (K) and the status of the clotting factors involved in the initial phases of coagulation [15,16]. K is an index of clot kinetics and firmness, whereas a is a measure of the speed at which the clot forms, and the maximum amplitude (MA) reflects the maximum strength of the clot and is a direct function of the dynamic properties of fibrin, fibrinogen level, and platelet function [15][16][17][18][19]. TMA is the Time to Maximum Amplitude or time to maximum strength.…”