Influence of fluid therapy on the haemostatic system of intensive care patients.
Haemostatic alterations associated with the use of fluids are related to non-specific dilutional effects and colloid-specific effects, such as acquired von Willebrand syndrome, inhibition of platelet function and fibrin polymerization. Judging by currently available evidence, dextran, hetastarch and pentastarch have a more pronounced impact than tetrastarch, gelatin and albumin. In patients with hypocoagulability, tetrastarch appears to be a suitable volume expander due to its high safety index and volume efficacy. Gelatins have lower inhibitory effects on clot strength compared with tetrastarch, but their volume efficacy is also lower. Dextrans are potent anticoagulants with a high risk for adverse reactions. Albumin has negligible effects on haemostasis, but low volume efficacy and costs limit the use of a blood product as a routine volume replacement fluid. To avoid potential acidosis-induced changes in haemostasis, plasma-adapted carrier solutions may be used instead of saline-based solutions.
Kozek-Langenecker
Sibylle A
SA
Department of Anaesthesiology, General Intensive Care and Pain Management, Vienna Medical University, Währinger Gürtel 18-20, 1090 Vienna, Austria. sibylle.kozek@meduniwien.ac.at
D001778:Blood Coagulation Disorders / Q000209:etiology*; D001792:Blood Platelets / Q000502:physiology; D003102:Colloids / Q000008:administration & dosage; D003422:Critical Care; D005440:Fluid Therapy / Q000009:adverse effects*; D006487:Hemostasis; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects; D013917:Thrombin / Q000096:biosynthesis
D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D013917:Thrombin