title: Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer's lactate on blood loss and coagulation after cardiac surgery.
abstract: BACKGROUND
  Infusion of 5% human albumin (HA) and 6% hydroxyethyl starch 130/0.4 (HES) during cardiac surgery expand circulating volume to a greater extent than crystalloids and would be suitable for a restrictive fluid therapy regimen. However, HA and HES may affect blood coagulation and could contribute to increased transfusion requirements.
  
  
  METHODS
  We randomly assigned 240 patients undergoing elective cardiac surgery to receive up to 50 ml kg(-1) day(-1) of either HA, HES, or Ringer's lactate (RL) as the main infusion fluid perioperatively. Study solutions were supplied in identical bottles dressed in opaque covers. The primary outcome was chest tube drainage over 24 h. Blood transfusions, thromboelastometry variables, perioperative fluid balance, renal function, mortality, intensive care unit, and hospital stay were also assessed.
  
  
  RESULTS
  The median cumulative blood loss was not different between the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL patients required blood products, compared with 62% (HA) and 64% (HES group; P=0.0003). Significantly, more study solution had to be administered in the RL group compared with the colloid groups. Total perioperative fluid balance was least positive in the HA group [6.2 (2.5) litre] compared with the HES [7.4 (3.0) litre] and RL [8.3 (2.8) litre] groups (P<0.0001). Both colloids affected clot formation and clot strength and caused slight increases in serum creatinine.
  
  
  CONCLUSIONS
  Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.
authors.affiliation: Division of Cardiothoracic and Vascular Anaesthesiology and Intensive Care Medicine, Department of Anaesthesiology, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Skhirtladze
authors.forename: E M
authors.initials: EM
authors.lastname: Base
authors.forename: A
authors.initials: A
authors.lastname: Lassnigg
authors.forename: A
authors.initials: A
authors.lastname: Kaider
authors.forename: S
authors.initials: S
authors.lastname: Linke
authors.forename: M
authors.initials: M
authors.lastname: Dworschak
authors.forename: M J
authors.initials: MJ
authors.lastname: Hiesmayr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000494:pharmacology*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000379:methods / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data; D006348:Cardiac Surgical Procedures; D017558:Elective Surgical Procedures / Q000379:methods; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006438:Hemodilution / Q000379:methods / Q000706:statistics & numerical data; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007552:Isotonic Solutions / Q000494:pharmacology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000494:pharmacology; D019106:Postoperative Hemorrhage / Q000188:drug therapy*; D000077325:Ringer's Lactate; D055815:Young Adult
chemical_list: D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate
keywords: Ringer's lactate; blood loss; coagulation; colloids; fluid regime; rotation thromboelastometry; transfusion