Acute haemodilution and prostaglandin E1-induced hypotension: effects on the coagulation-fibrinolysis system.
The effects of acute haemodilution, during prostaglandin E1 (PGE1)-induced hypotension, on the blood coagulation-fibrinolysis system were studied in 40 patients undergoing hip surgery. The patients were randomly divided into four groups of 10 patients each; Group A (control) received no induced hypotension or haemodilution, group B received hypotension alone, group C received haemodilution alone and group D received the combination of induced hypotension and haemodilution. Haemodilution in groups C and D was produced by drawing approximately 1000 mL of blood and replacing it with the same amount of 6% hydroxyethyl starch. Induced hypotension in groups B and D was conducted with PGE1 and mean blood pressure was maintained at 55 mmHg. The mean dosage of PGE1 was 648 micrograms in group B and 661 micrograms in group D. In the control and PGE1-induced hypotension groups there was no significant change in platelet count (PLT), prothrombin time (PT), activated partial thromoplastin time (aPTT), fibrinogen (FIB), antithrombin-III (AT-III) or plasminogen (PLG). Haemodilution alone caused significant decreases in PLT (-43%), PT (+21%), FIB (-33%), AT-III (-21%) and PLG (-27%), and a significant increase in aPTT (+26%), whereas the combination of PGE1-induced hypotension did not cause any further change in these parameters. Serum-fibrin degradation products (FDP) significantly increased (+300%) and PLG significantly decreased (-30%) after surgery in all groups. It can be concluded that acute haemodilution to a haematocrit value of 22 +/- 2% causes a slight coagulopathy, which is not enhanced when combined with PGE1-induced hypotension.
Fukusaki
M
M
Department of Anaesthesia, Nagasaki Rosai Hospital, Japan.
Maekawa
T
T
Miyako
M
M
Niiya
S
S
Sumikawa
K
K
D000368:Aged; D000527:Alprostadil / Q000494:pharmacology*; D000758:Anesthesia; D001777:Blood Coagulation / Q000187:drug effects*; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006438:Hemodilution; D006490:Hemostatics / Q000494:pharmacology; D006622:Hip Prosthesis; D006801:Humans; D007023:Hypotension, Controlled; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology; D014665:Vasodilator Agents / Q000494:pharmacology*
D006490:Hemostatics; D010952:Plasma Substitutes; D014665:Vasodilator Agents; D000527:Alprostadil