Prospective double-blind randomized study of the effects of four intravenous fluids on platelet function and hemostasis in elective hip surgery.
A prospective randomized double-blind study was performed to determine the effects of three colloids, Haemaccel, Gelofusine and albumin, and also saline on platelet activation, platelet aggregation (induced by adenosine diphosphate (ADP), epinephrine, collagen) platelet agglutination by ristocetin and other hemostatic variables in 55 patients undergoing primary unilateral total hip replacement. The fluids were administered according to normal clinical practice and assessments were made immediately before, at the end, and 2 h after the end of surgery. Surgery was accompanied by thrombin generation (increases in thrombin/antithrombin III complex, prothrombin F1 +2 fragment) platelet activation (betaTG) and compromised coagulation. Generally, the platelet activation appeared to result in platelet desensitization and brought about a persistent reduction in platelet aggregation to ADP and epinephrine, irrespective of the fluid used. Additionally, Haemaccel and Gelofusine inhibited ristocetin-induced platelet agglutination and albumin inhibited collagen-induced platelet aggregation. Gross inhibitory effects of Haemaccel that had been predicted from an earlier in vitro study did not occur. Particular fluids had selective additional effects on the hemostatic system. Albumin infusion served to maintain plasma albumin at normal concentrations postsurgery. The two gelatin preparations, Haemaccel and Gelofusine, maintained plasma viscosity. All three colloids led to a transient increase in activated partial thromboplastin time postsurgery and also a transient fall in the concentration of factor VIII, which were accompanied by a transient increase in bleeding time, but there was no measurable increase in blood loss. Inhibition of platelet aggregation by certain colloids may provide additional protection against the increased thrombotic risk in patients following major surgery.
Evans
P A
PA
Accident and Emergency Department, Morriston Hospital, Swansea, UK.
Heptinstall
S
S
Crowhurst
E C
EC
Davies
T
T
Glenn
J R
JR
Madira
W
W
Davidson
S J
SJ
Burman
J F
JF
Hoskinson
J
J
Stray
C M
CM
D000244:Adenosine Diphosphate / Q000378:metabolism; D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000990:Antithrombin III / Q000096:biosynthesis; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D001760:Bleeding Time; D001769:Blood / Q000378:metabolism; D001777:Blood Coagulation / Q000187:drug effects*; D001792:Blood Platelets / Q000187:drug effects*; D003102:Colloids / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004837:Epinephrine / Q000096:biosynthesis / Q000494:pharmacology; D005260:Female; D005780:Gelatin / Q000737:chemistry / Q000627:therapeutic use; D006400:Hematocrit; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000096:biosynthesis; D010952:Plasma Substitutes / Q000627:therapeutic use; D015539:Platelet Activation; D010974:Platelet Aggregation; D011097:Polygeline / Q000627:therapeutic use; D011446:Prospective Studies; D011498:Protein Precursors / Q000096:biosynthesis; D011516:Prothrombin / Q000096:biosynthesis; D012310:Ristocetin / Q000494:pharmacology / Q000627:therapeutic use; D012965:Sodium Chloride / Q000494:pharmacology; D013386:Succinates / Q000627:therapeutic use; D013917:Thrombin / Q000096:biosynthesis; D013997:Time Factors; D001620:beta-Thromboglobulin / Q000096:biosynthesis
D000418:Albumins; D000900:Anti-Bacterial Agents; D003102:Colloids; D010446:Peptide Fragments; D010952:Plasma Substitutes; D011498:Protein Precursors; D013386:Succinates; D001620:beta-Thromboglobulin; D012310:Ristocetin; C060085:succinylated gelatin; D012965:Sodium Chloride; D000244:Adenosine Diphosphate; C029733:prothrombin fragment 1; C044183:prothrombin fragment 2; D005780:Gelatin; D000990:Antithrombin III; D011516:Prothrombin; D011097:Polygeline; D013917:Thrombin; D004837:Epinephrine