Fluid resuscitation is an essential part of managing patients with major trauma, as well as in the perioperative setting. Common misconceptions exist regarding the role of fluid therapy in maintaining, enhancing or inhibiting normal coagulation and haemostasis. This review provides an overview of the basic coagulation processes, as well as the influence of intravenous crystalloid and colloid preparations on haemostasis and coagulation. The use of point-of-care devices is encouraged as a feasible way of monitoring these effects in the acute setting.
Bennett-Guerrero E, Frumento RJ, Metz B, Manspeizer HE, Hirsh AL.2001. Impact of normal saline based versus balanced-saltintravenousfluid replacementon clinical outcomes:a randomizedblinded clinical trial. Anesthesiology95: A147-A147.
2.
Bergqvist D.1982. Dextran and haemostasis. A review. Acta Chir Scand148: 633-640.
3.
Bergqvist D.1993. Dextran. In: Goldhaber SJ ed. Prevention of venous thromboembolism. New York: Marcel Dekker, Inc: pp. 167-195.
4.
Blumberg N, Heal J, Chuang C, Murphy P, Agarwal M.1988. Further evidence supporting a cause and effect relationship between blood transfusion and earlier cancer recurrence. Ann Surg207: 410-415.
5.
Boldt J, Haisch G, Suttner S, Kumle B, Schellhaass A.2002. Effects of a new modified, balanced hydro-xyethyl starch preparation (Hextend) on measures of coagulation. Br J Anaesth89: 722-728.
6.
Caprini JA, Arcelus JI, Goldshteyn S, Hoffman KN, Coats RW II. 1995. Thromboelastography: measuring statistical probabilities. Seminars in Thrombosis and Hemostasis 21: 14-20.
7.
Clagett GP, Reisch JS.1988. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann. Surg.208: 227-240.
8.
Curi MA, Skelly CL, Baldwin ZKet al.2003. Long-term outcome of infrainguinal bypass grafting in patients with serologicallyprovenhypercoagulability.J. Vasc. Surg.37: 301-306.
9.
Egli GA, Zollinger A, Seifert B, Popovic D, Pasch T, Spahn DR.1997. Effect of progressivehaemodilution with hydroxyethyl starch, gelatin and albumin on blood coagulation. Br J Anaesth78: 684-689.
10.
Egli G, Spahn D. 1997. Does hemodilution enhance or compromise blood coagulation?. Seminars in Cardiothoracic and Vascular Anesthesia 1: 342-348.
11.
Farrar D, Lee J, Mutch Met al.Plasma volume changes associatedwith commonlyused colloids following acute hypovolaemia.Proceedingsof the 8th World Congress of Intensive and Critical Care Medicine. Sydney, Australia, 2001 (Abstract).
12.
Gan TJ, Bennett-Guerrero E, Phillips-Bute Bet al.1999. Hextend, a physiologicallybalancedplasma expander for large volume use in major surgery: a randomized phase III clinical trial. Hextend Study Group. Anesth Analg88: 992-998.
13.
Griffel MI, Kaufman BS.1992. Pharmacologyof colloids and crystalloids. Crit Care Clin8: 235-253.
14.
HattersleyPG. 1966.Activatedcoagulationtime of whole blood. JAMA196: 436-440.
15.
Hattersley PG, Mitsuoka JC, Ignoffo RJ, King JH, Musallam NA.1983. Adjusting heparin infusion rates from the initial response to activated coagulation time. Drug Intell Clin Pharm17: 632-634.
16.
Heather BP, Jennings SA, Greenhalgh RM.1980. The saline dilution test - a preoperativepredictorof DVT. Br J Surg67: 63-65.
17.
Hett DA, Walker D, Pilkington SN, Smith DC.1995. Sonoclot analysis. Br J Anaesth75: 771-776.
Imm A, Carlson RW.1993. Fluid resuscitation in circulatory shock. Crit Care Clin9: 313-333.
20.
Jamnicki M, Zollinger A, Seifert B, Popovic D, Pasch T, Spahn DR.1998. The effect of potato starch derived and corn starch derived hydroxyethyl starch on in vitro blood coagulation. Anaesthesia53: 638-644.
21.
Janvrin SB, Davies G, Greenhalgh RM.1980. Postoperative deep vein thrombosis caused by intravenous fluids during surgery. Br J Surg67: 690-693.
22.
Kang Y.1995. Thromboelastographyin liver transplantation. Seminars in Thrombosis and Hemostasis21: 34-44.
23.
KaufmannCR, Dwyer KM, Crews JD, Dols SJ, Trask AL.1997. Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma42: 716-720.
24.
Laxenaire MC, Charpentier C, Feldman L.1994. Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multi-center prospective study. Ann Fr Anesth Reanim13: 301-310.
25.
Lockwood DN, Bullen C, Machin SJ.1988. A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah’s Witness. Anaesthesia43: 391-393.
Mardel SN, Saunders FM, Allen Het al.1998. Reduced quality of clot formation with gelatin-based plasma substitutes. Br J Anaesth80: 204-207.
28.
Martin G, Bennett-Guerrero E, Wakeling Het al.2002. A prospective, randomized comparison of thromboelastographiccoagulationprofile in patients receiving lactated Ringer’s solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery. J CardiothoracVasc Anesth16: 441-446.
29.
Mezrow CK, Bergstein I, Tartter PI.1992. Postoperative infections following autologous and homologous blood transfusions. Transfusion32: 27-30.
30.
Ruttmann TG, James MF, Aronson I.1998. In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200=0.5) and normal saline on coagulation[see comments]. Br J Anaesth80: 612-616.
31.
Ruttmann TG, James MF, Finlayson J.2002. Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery. Br J Anaesth89: 226-230.
32.
Ruttmann TG, Jamest MF, Lombard EH.2001. Haemodilution-inducedenhancement of coagulation is attenuated in vitro by restoring antithrombin III to pre-dilution concentrations. Anaesth Intensive Care29: 489-493.
33.
Salmon JB, Mythen MG.1993. Pharmacology and physiology of colloids. Blood Rev7: 114-120.
Schierhout G, Roberts I.1998. Fluid resuscitation with colloid or crystalloid solutionsin critically ill patients: a systematic review of randomised trials. BMJ316: 961-964.
36.
Sharma SK, Philip J, Wiley J.1997. Thromboelastographic changes in healthy parturients and postpartum women. Anesth Analg85: 94-98.
37.
Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA.1999. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg88: 312-319.
38.
Spahn DR, Leone BJ, Reves JG, Pasch T.1994. Cardiovascular and coronary physiology of acute isovolemic hemodilution: a review of nonoxygen-carrying and oxygen-carrying solutions. Anesth Analg78: 1000-1021.
39.
Spiess BD.1995. Thromboelastography and cardio-pulmonary bypass. Semin Thromb Hemost21: 27-33.
40.
Steinbauer M, Harris AG, Leiderer R, Abels C, Messmer K.1998. Impact of dextran on microvascular disturbances and tissue injury following ischemia= reperfusion in striated muscle. Shock9: 345-351.
41.
Tabuchi N, de Haan J, GallandatHuet RC, Boonstra PW, van Oeveren W.1995. Gelatin use impairs platelet adhesion during cardiac surgery. Thromb Haemost74: 1447-1451.
42.
Traverso CI, Caprini JA, Arcelus JI.1995. The normal thromboelastogram and its interpretation. Semin Thromb Hemost21: 7-13.
43.
Treib J, Haass A, Pindur G.1997. Coagulation disorders caused by hydroxyethyl starch. Thromb Haemost78: 974-983.
44.
Treib J, Haass A, Pindur Get al.1996. All medium starches are not the same: influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation. Transfusion36: 450-455.
45.
Treib J, Haass A, Pindur Get al.1995. HES 200=0.5 is not HES 200=0.5. Influence of the C2=C6 hydro-xyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost74: 1452-1456.
46.
Tuman KJ, Spiess BD, McCarthy RJ, Ivankovich AD.1987. Effects of progressiveblood loss on coagulation as measured by thrombelastography. Anesth Analg66: 856-863.
47.
Turner ML, Ironside JW.1998. New-variant Creutzfeldt-Jakob disease: the risk of transmission by blood transfusion. Blood Rev12: 255-268.
48.
Wade CE, Grady JJ, Kramer GC.2003. Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma. J Trauma54: S144-S148.
49.
Wade CE, Grady JJ, Kramer GC, Younes RN, Gehlsen K, Holcroft JW.1997. Individual patient cohort analysis of the efficacy of hypertonic saline=dextran in patients with traumatic brain injury and hypotension. J Trauma42: S61-S65.
50.
Ward JW, Holmberg SD, Allen JRet al.1988. Transmission of human immunodeficiency virus (HIV) by blood transfusions screened as negative for HIV antibody. N Engl J Med318: 473-478.
51.
Waters JH, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR.2001. Normal saline versus lactated Ringer’s solution for intraoperative fluid managementin patient sunder going abdominalaortic aneurysm repair: an outcome study. Anesth. Analg.93: 817-822.
52.
Wilkes NJ, Woolf R, Mutch Met al.2001. The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg93: 811-816.
53.
Williams EL, Hildebrand KL, McCormick SA, Bedel MJ.1999. The effect of intravenous lactated Ringer’s solution versus 0.9% sodium chloride solution on serum osmolality in human volunteers. Anesth Analg88: 999-1003.
54.
Zuckerman L, Cohen E, Vagher JP, Woodward E, Caprini JA.1981. Comparison of thrombelastography with common coagulation tests. Thromb Haemost46: 752-756.
