The effects of perioperatively administered crystalloids and colloids on concentrations of molecular markers of activated coagulation and fibrinolysis.
To explore whether intravenous administration of routinely used crystalloid or colloid solutions differently affects the coagulation system, we investigated orthopaedic patients. Since crystalloid solutions might cause hypercoagulability, we here present our results on molecular markers of coagulation and fibrinolysis. Patients undergoing knee replacement surgery randomly received isovolemic amounts of lactated Ringer's solution, 6% hydroxyethyl starch 200/0.5 or 4% modified gelatine. Arterial blood samples for determination of specific molecular markers of activated coagulation (thrombin/antithrombin complex, D-dimer, prothrombin fragment F1 + 2), fibrinolysis (plasmin/alpha 2-antiplasmin complex, tissue plasminogen activator, plasminogen activator inhibitor-1), and concentrations of coagulation factor XIII were obtained at baseline, before tourniquet release, at the end of surgery and 2 h after operation. During the observation period, thrombin/antithrombin complex increased from 4.8 to 54.7 microg/l, D-dimer increased from 0.3 to 6.0 mg/ml, prothrombin fragment F1 + 2 increased from 1.7 to 5.9 nmol/l, tissue plasminogen activator decreased from 7.3 to 6.7 ng/ml, plasminogen activator inhibitor-1 increased from 68.4 to 71.0 ng/ml, plasmin/alpha 2-antiplasmin complex increased from 281.5 to 884 microg/l and factor XIII decreased from 89.0 to 58.5%. All parameters changed significantly but without any detectable difference in the response profile between the groups receiving different intravenous fluids. During knee replacement surgery a pronounced activation of the coagulation/fibrinolytic system was observed, regardless of whether patients received crystalloid or colloid fluids. Thus, these results cannot confirm the hypothesis that crystalloid fluids per se cause hypercoagulability in vivo.
Fries
Dietmar
D
Department of Anaesthesia and Critical Care Medicine, The Leopold-Franzens University of Innsbruck, Innsbruck, Austria. Dietmar.Fries@uibk.ac.at
Streif
Werner
W
Margreiter
Josef
J
Klingler
Anton
A
Kühbacher
Gabriele
G
Schobersberger
Wolfgang
W
Wirleitner
Barbara
B
Innerhofer
Petra
P
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation / Q000187:drug effects*; D019774:Blood Coagulation Factor Inhibitors / Q000032:analysis; D001779:Blood Coagulation Factors / Q000032:analysis; D003102:Colloids / Q000008:administration & dosage / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D005342:Fibrinolysis / Q000187:drug effects*; D005780:Gelatin / Q000008:administration & dosage / Q000494:pharmacology; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology; D007552:Isotonic Solutions; D008875:Middle Aged; D009985:Orthopedics; D019990:Perioperative Care; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000627:therapeutic use; D019851:Thrombophilia / Q000139:chemically induced / Q000209:etiology
D015415:Biomarkers; D019774:Blood Coagulation Factor Inhibitors; D001779:Blood Coagulation Factors; D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D005780:Gelatin