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The effect of the combined administration of colloids and Ringer's Lactate on the coagulation system - an in vitro study using thrombelastography (roTEG®)

Introduction

Gelatine and hydroxyethylstarch (HES) based colloids are given in clinical practice normally in combination with Ringer's Lactate (RL), but also dose dependent combinations of HES and gelatine are administered. Colloids impair the coagulation system in different ways: gelatine disturbs fibrin polymerisation and HES reduces F VIII and vWF in plasma in the first line. There are no data available, to which extent the combined administration of colloids and RL affects the coagulation system. Aim of our study was to investigate, if the combined administration handicaps the coagulation system differently than the use of single substances.

Methods

We diluted citrated blood from 10 healthy male volunteers to 20%, 40% and 60% with gelatine (Gelofusin®), 6% HES 130:0,4 (Voluven®), 6% HES 200:0.5 (Iso-Hes®) and RL, as well as with the combinations of these solutions in a ratio of 1:1 (gelatine/RL, 6% HES 130:0.4/RL, 6% HES 130:0.4/gelatine, 6% HES 200:0.5/RL, 6% HES 200:0.5/gelatine). Thereafter, blood was recalcified, the samples were activated with InTec® (thromboplastin, Nobis®) and analysed by modified thrombelastography (roTEG®). A repeated measures ANOVA as applied for the analysis of the influence of dilution on thromboelastographic parameters, different colloid combinations were compared using an ANOVA after subtracting the 0% dilution value and Tukey's post hoc tests for individual intergroup comparisons.

Results

We could not detect any significant differences between the combination gelatine/RL and 6% HES 130:0.4/RL. The clot formation time (CFT) of 6% HES 200:0.5/RL was significant longer than gelatine/RL at 40% and 60% dilution. At 40% dilution, the CFT of 6% HES 130:0.4/RL and gelatine/RL was significant shorter and the maximal clot formation (MCF) significant higher than 6% HES 130:0.4 and 6% HES 200:0.5 alone.

Conclusion

Concerning to our data, 6% HES 200:0.5 and the combination of 6% HES 200:0.5/RL impair the coagulation system more than the combination of gelatien/RL or 6% HES 130:0.4/RL. Regarding its influence on the coagulation system, 6% HES 130:0.4 may be as safe as gelatine in patients with blood loss and huge volume substitution.

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Fries, D., Innerhofer, P., Klingler, A. et al. The effect of the combined administration of colloids and Ringer's Lactate on the coagulation system - an in vitro study using thrombelastography (roTEG®). Crit Care 5, P112 (2001). https://doi.org/10.1186/cc1179

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Keywords

  • Repeated Measure ANOVA
  • Male Volunteer
  • Healthy Male Volunteer
  • Coagulation System
  • Hydroxyethylstarch