title: Are lactated Ringer's solution and normal saline solution equal with regard to coagulation?
abstract: Crystalloids represent an attractive strategy to alleviate intravascular volume deficits. Crystalloid hemodilution was associated with hypercoagulability in in vitro and in vivo studies. The influence of different crystalloids on coagulation in the surgical patient is not well studied. In a prospective, randomized study in patients undergoing major abdominal surgery, we used either lactated Ringer's solution (RL) (n = 21) or 0.9% saline solution (SS) (n = 21) exclusively for intravascular volume replacement over 48 h to maintain central venous pressure between 8 and 12 mm Hg. Activated thrombelastography (TEG) using different activators (intrinsic TEG, extrinsic TEG, heparinase TEG, aprotinin TEG) was used to measure coagulation time, clot formation time, and maximum clot firmness. Measurements were performed after induction of anesthesia (T0), immediately after surgery (T1), 5 h after surgery (T2), and on the morning of the first (T3) and second (T4) postoperative days. RL 18,750 +/- 1890 mL and 17,990 +/- 1790 mL of SS were infused during the study period. Acidosis was seen only in the SS-treated group. Blood loss was not different between the groups. Fibrinogen and antithrombin III decreased similarly at T1 and T2 in both groups, most likely because of hemodilution. Differences in TEG data from normal baseline were seen only immediately after surgery and 5 h thereafter, indicating mild hypercoagulability in the intrinsic TEG (RL, from 147 +/- 130 s to 130 +/- 11 s; SS, from 146 +/- 12 s to 131 +/- 12 s). There were no differences in coagulation between RL- and SS-treated patients. We conclude that in major abdominal surgery intravascular volume replacement with crystalloids resulted in only moderate and abbreviated changes in coagulation. No differences in activated TEG and blood loss were seen between an RL- and an SS-based intravascular volume replacement regimen.
  
  
  CONCLUSIONS
  In 42 patients undergoing major abdominal surgery, either lactated Ringer's solution or 0.9% saline solution were exclusively used for volume therapy for 48 h. Activated thrombelastography revealed some mild hypercoagulability after surgery. No differences in coagulation were seen between the two intravascular volume replacement strategies.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: G
authors.initials: G
authors.lastname: Haisch
authors.forename: S
authors.initials: S
authors.lastname: Suttner
authors.forename: B
authors.initials: B
authors.lastname: Kumle
authors.forename: F
authors.initials: F
authors.lastname: Schellhase
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects*; D002496:Central Venous Pressure; D000077324:Crystalloid Solutions; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000601:surgery; D006438:Hemodilution; D006801:Humans; D007552:Isotonic Solutions / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology; D011446:Prospective Studies; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000494:pharmacology*; D013916:Thrombelastography
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012965:Sodium Chloride