A prospective, randomized comparison of thromboelastographic coagulation profile in patients receiving lactated Ringer's solution, 6% hetastarch in a balanced-saline vehicle, or 6% hetastarch in saline during major surgery.
OBJECTIVE
To compare the effects of lactated Ringer's solution (LR), 6% hetastarch in a balanced-saline vehicle (HS-BS), and 6% hetastarch in normal saline (HS-NS) on coagulation using thromboelastography.


METHODS
Prospective, randomized double-blinded evaluation of previously published clinical trial.


METHODS
Tertiary-care medical center.


METHODS
Patients undergoing elective noncardiac surgery with an anticipated blood loss >500 mL. A total of 90 patients were enrolled with 30 patients in each group.


METHODS
Patients received a standardized anesthetic. LR, HS-BS, and HS-NS were administered intraoperatively based on a fluid administration algorithm. Hemodynamic targets included maintenance of arterial blood pressure, heart rate, and urine output within a predefined range.


RESULTS
Thromboelastography variables for r time, k time, maximum amplitude, and alpha angle (mean +/- SD) were recorded at induction of anesthesia, at the end of surgery, and 24 hours postoperatively. Patients in the LR group showed a state of hypercoagulation at the end of surgery with reductions (p < 0.005) in r time (-3.8 +/- 6.7 mm) and k time (-1.7 +/- 2.5 mm). This state of hypercoagulation continued into the postoperative period. Patients in the HS-NS group showed a state of hypocoagulation with increases (p < 0.05) in r time (+6.2 +/- 8.5 mm) and k time (+1.7 +/- 3.9 mm) and a reduction in maximum amplitude (-8.0 +/- 9.8 mm) at the end of surgery. This state of hypocoagulation was reduced in the postoperative period. Patients in the HS-BS group showed no significant changes in coagulation status at end of surgery, with the smallest changes in r time (-0.3 +/- 4.1 mm), k time (+0.1 +/- 3.1 mm), maximum amplitude (-5.4 +/- 12.3 mm), and alpha angle (0.3 +/- 12.5 degrees ).


CONCLUSIONS
LR-treated patients exhibited a hypercoagulative profile that persisted into the postoperative period. HS-BS administration was associated with a lesser change in the coagulation profile compared with HS-NS, which was associated with a hypocoagulative state.
Martin
G
G
Department of Anesthesiology, and Division of Biometry, Duke University Medical Center, Durham, NC 27710, USA.
Bennett-Guerrero
E
E
Wakeling
H
H
Mythen
M G
MG
el-Moalem
H
H
Robertson
K
K
Kucmeroski
D
D
Gan
T J
TJ
D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects*; D004311:Double-Blind Method; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008875:Middle Aged; D009657:North Carolina; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011184:Postoperative Period; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D000077325:Ringer's Lactate; D012965:Sodium Chloride / Q000627:therapeutic use*; D013916:Thrombelastography; D016896:Treatment Outcome
D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate; D012965:Sodium Chloride