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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer’s vs. Dextran - a randomized controlled trial

Authors: Kirsten C. Rasmussen, Michael Hoejskov, Per I. Johansson, Irina Kridina, Thomas Kistorp, Lisbeth Salling, Henning B. Nielsen, Birgitte Ruhnau, Tom Pedersen, Niels H. Secher

Published in: BMC Anesthesiology | Issue 1/2015

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Abstract

Background

Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.

Methods

Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer’s solution or Dextran 70 (Macrodex ®) that affects coagulation competence.

Results

By thrombelastography evaluated coagulation competence, Dextran 70 reduced “maximal amplitude” (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer’s solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer’s group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = −0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer’s group (P = 0.04).

Conclusions

With the use of Dextran 70 vs. lactated Ringer’s solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.

Trial registration

The study was accepted on January 7th, 2013 at www.​clinicaltrialsre​gister.​eu EudraCT 2012-005040-20.
Literature
1.
Johansson PI, Stensballe J. Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets – a review of the current literature. Tranfusion. 2010;50:701–10.CrossRef
2.
Gruen RL, Brohi K, Schreiber M, Balogh ZJ, Pitt V, Narayan M et al. Hemorrhage control in severely injured patients. Lancet. 2012;380:1099–108.
3.
Lunde J, Stensballe J, Wikkelsø A, Johansen M, Afshari A. Fibrinogen concentrate for bleeding – a systematic review. Acta Anesthesiol Scand. 2014; doi:10.​1111/​aas.​12370.
4.
Zaar M, Lauritzen B, Secher NH, Krantz T, Nielsen HB, Madssen PL et al. Initial administration of hydroxyethyl starch vs. lactated Ringer after liver trauma in the pig. Br J Anaesth. 2009;102:221–6.
5.
Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013;2:CD000567.PubMed
6.
Skhirtladze K, Base EM, Lassnigg A, Kaider A, Linke S, Dworschak M et al. Comparison of the effects of albumin 5 %, hydroxyethyl starch 130/0.4 6 %, Ringer’s lactate on blood loss and coagulation after cardiac surgery. Br J Anaesth. 2013;112:255–64.
7.
Innerhofer P, Fries D, Margreiter J, Klingler A, Kühbacher G, Wachter B et al. The effects of intraoperatively administered colloids and crystalloids on primary platelet-mediated hemostasis and clot formation. Anesth Analg. 2002;95:858–65.
8.
Rasmussen KC, Johansson PI, Hoejskov M, Kridina I, Kistorp T, Thind P et al. Hydroxyethyl starch reduces coagulation competence and increase blood loss during major surgery. Results from a randomized controlled trial. Ann Surg. 2014;2:249–54.
9.
ICH Steering Committee. International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use: ICH harmonised tripartite guideline for good clinical practice. 3rd ed. London: Brookwood Med Pub; 1998.
10.
de Vaal JB, de Wilde RB, van den Berg PC, Schreuder JJ, Jansen JR. Less invasive determination of cardiac output from the arterial pressure by aortic diameter-calibrated pulse contour. Br J Anaesth. 2005;95:326–31.CrossRefPubMed
11.
Bundgaard-Nielsen M, Holte K, Secher NH, Kehlet H. Monitoring of intraoperative fluid administration by individualized goal-directed therapy. Acta Anaesthesiol Scand. 2007;51:331–40.CrossRefPubMed
12.
Johansson PI, Svendsen MS, Salado J, Bochsen L, Kristensen AT. Investigation of the thrombin-generating capacity, evaluated by thrombogram and clot formation evaluated by thrombelastography of platelets stored in the blood bank for up to 7 days. Vox Sang. 2008;94:113–8.CrossRefPubMed
13.
Pedersen T. Evidence-based anesthesia and health economics. Best Pract Res Clin Anaesthesiol. 2006;20:347–60.CrossRefPubMed
14.
Senagore AJ, Emery T, Luchtefeld M, Kim D, Dujovny N, Hoedema R. Fluid management for laparoscopic colectomy: a prospective, randomized assessment of goal-directed administration of balanced salt solution or hetastarch coupled with an enhanced recovery program. Dis Colon Rectum. 2009;52:1935–40.CrossRefPubMed
15.
Bundgaard-Nielsen M, Wilson TE, Seifert T, Secher NH, Crandall CG. Effect of volume loading on the Frank-Starling relation during reductions in central blood volume in heat-stressed humans. J Physiol. 2010;588:3333–9.CrossRefPubMedPubMedCentral
16.
Boffard KD. Resuscitation physiology. In: Boffard KD, editor. Manual of definitive surgical trauma care. Hodder/Arnold: Oxford University Press; 2003. p. 7–40.
17.
Randell T, Lindgren L, Yli-Hankala A, Hekali R, Orko R, Lalla M. The effect of dextran infusion on antithrombin III concentrations and on platelet function during minor surgery. Ann Chir Gynaecol. 1996;85:17–21.PubMed
18.
Annane D, Siami S, Jaber S, Martin C, Elatrous S, Declère AD et al. Effects of fluid resuscitation with colloids vs. crystalloids on mortality in critically ill patients presenting with hypovolemic shock. The CRISTAL randomized trial. JAMA. 2013;17:1809–17.
19.
Hahn RG. Crystalloid and colloid fluids. In: Hahn RG, editor. Clinical fluid therapy in the intraoperative setting. Cambridge: Cambridge University Press; 2011. p. 1–29.CrossRef
20.
Hahn RG. Fluid therapy in uncontrolled hemorrhage – what experimental models have taught us.Review article. Acta Anaesthesiol Scand. 2013;57(1):16–28.CrossRefPubMed
21.
Bundgaard-Nielsen M, Secher NH, Kehlet H. ’Liberal’ vs.’restrictive’ intraoperative fluid therapy: a critical assessment of the evidence. Acta Anaesthesiol Scand. 2009;53:843–51.CrossRefPubMed
22.
23.
Corcoran T, Rhodes JE, Clarke S, Myles PS, Ho KM. Intraoperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114:640–51.CrossRefPubMed
24.
Kruer RM, Ensor CR. Colloids in the intensive care unit. Am J Health Syst Pharm. 2012;69:1635–42.CrossRefPubMed
25.
Cammerer U, Dietrich W, Rampf T, Braun SL, Richer JA. The predictive value of modified computerized tromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg. 2003;96:51–7.PubMed
Metadata
Title
Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer’s vs. Dextran - a randomized controlled trial
Authors
Kirsten C. Rasmussen
Michael Hoejskov
Per I. Johansson
Irina Kridina
Thomas Kistorp
Lisbeth Salling
Henning B. Nielsen
Birgitte Ruhnau
Tom Pedersen
Niels H. Secher
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0162-1

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