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CRITICAL CARE AND TRAUMA

The Effect of the Combined Administration of Colloids and Lactated Ringer’s Solution on the Coagulation System: An In Vitro Study Using Thrombelastograph^® Coagulation Analysis (ROTEG^®)

Dietmar Fries, MD^*, Petra Innerhofer, MD^*, Anton Klingler, PhD, Ulrike Berresheim, MD^*, Markus Mittermayr, MD^*, Andreas Calatzis, MD, and Wolfgang Schobersberger, MD^*

*Department of Anesthesia and Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck; Department of Theoretical Surgery, University of Innsbruck, Innsbruck, Austria; and Department of Hemostaseology, University Hospital Munich, Munich, Germany

Address correspondence and reprint requests to Dr. Dietmar Fries, Department of Anesthesia and Intensive Care Medicine, The Leopold-Franzens-University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. Address e-mail to dietmar.fries{at}uibk.ac.at

Gelatin solutions are often given in clinical practice once the maximal dose of a median-weight hydroxyethyl starch (HES) has been reached. Colloids are usually combined with lactated Ringer’s solution (RL). Whether the combined administration of colloids and/or crystalloids affects blood coagulation is not known. We diluted blood by 20%, 40%, and 60% with RL, gelatin (Gelofusin^®), 6% HES 130/0.4 (Voluven^®), and 6% HES 200/0.5 (Iso-Hes^®), as well as with combinations of these solutions at a ratio of 1:1 (gelatin/RL, 6% HES 130/0.4:RL, 6% HES 200/0.5:RL, 6% HES 130/0.4:gelatin, 6% HES 200/0.5:gelatin). Thereafter, blood was analyzed by using modified thrombelastograph^® coagulation analysis (ROTEG^®) and clotting time, clot formation time, and maximal clot firmness were determined. RL had the least effect on hemostasis. Gelatin administered alone impaired the coagulation system significantly less than each median-weight HES administered alone. We conclude that gelatin combined with 6% HES 200/0.5 or 6% HES 130/0.4 decreases hemostasis <6% HES 200/0.5 or 6% HES 130/0.4 administered alone.

IMPLICATIONS: The effect of the combined administration of different colloids and/or crystalloids on coagulation is not known. We show that hemostasis is less impaired using a combination of gelatin and median-weight starches than using median-weight starches alone. Furthermore, the combination of lactated Ringer’s solution and gelatin decreases the coagulation system to the same extent as the combination of lactated Ringer’s solution and 6% hydroxyethyl starch 130/0.4.

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