title: Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs.
abstract: OBJECTIVE
  To compare the in vitro effects of hypertonic solutions and colloids to saline on coagulation in dogs.
  
  
  METHODS
  In vitro experimental study.
  
  
  METHODS
  Veterinary teaching hospital.
  
  
  METHODS
  Twenty-one adult dogs.
  
  
  METHODS
  Blood samples were diluted with saline, 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH), 7.2% hypertonic saline (HTS), hydroxyethyl starch (HES) 130/0.4 or hydroxyethyl starch 600/0.75 at ratios of 1:22 and 1:9, and with saline and HES at a ratio of 1:3.
  
  
  RESULTS
  Whole blood coagulation was analyzed using rotational thromboelastometry (extrinsic thromboelastometry-cloting time (ExTEM-CT), maximal clot firmness (MCF) and clot formation time (CFT) and fibrinogen function TEM-CT (FibTEM-CT) and MCF) and platelet function was analyzed using a platelet function analyzer (closure time, CTPFA ). All parameters measured were impaired by saline dilution. The CTPFA was prolonged by 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH) and HTS but not by HES solutions. At clinical dilutions equivalent to those generally administered for shock (saline 1:3, HES 1:9, and hypertonic solutions 1:22), CTPFA was more prolonged by HH and HTS than other solutions but more by saline than HES. No difference was found between the HES solutions or the hypertonic solutions. ExTEM-CFT and MCF were impaired by HH and HTS but only mildly by HES solutions. At clinically relevant dilutions, no difference was found in ExTEM-CFT between HTS and saline or in ExTEM-MCF between HH and saline. No consistent difference was found between the 2 HES solutions but HH impaired ExTEM-CFT and MCF more than HTS. At high dilutions, FibTEM-CT and -MCF and ExTEM-CT were impaired by HES.
  
  
  CONCLUSIONS
  Hypertonic solutions affect platelet function and whole blood coagulation to a greater extent than saline and HES. At clinically relevant dilutions, only CTPFA was markedly more affected by hypertonic solutions than by saline. At high dilutions, HES significantly affects coagulation but to no greater extent than saline at clinically relevant dilutions.
authors.affiliation: Division of Small Animal Emergency and Critical Care, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Virginie A
authors.initials: VA
authors.lastname: Wurlod
authors.affiliation: the Diagnostic Laboratory, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Judith
authors.initials: J
authors.lastname: Howard
authors.affiliation: Small Animal Internal Medicine, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Thierry
authors.identifier: http://orcid.org/0000-0002-6693-5365
authors.initials: T
authors.lastname: Francey
authors.affiliation: Small Animal Internal Medicine, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Ariane
authors.initials: A
authors.lastname: Schweighauser
authors.affiliation: Division of Small Animal Emergency and Critical Care, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Katja N
authors.initials: KN
authors.lastname: Adamik
mesh_terms: D000293:Adolescent; D000818:Animals; D001777:Blood Coagulation / Q000187:drug effects; D001780:Blood Coagulation Tests; D001792:Blood Platelets / Q000187:drug effects*; D004285:Dogs; D005340:Fibrinogen / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D010979:Platelet Function Tests / Q000662:veterinary; D012462:Saline Solution, Hypertonic / Q000494:pharmacology*; D012965:Sodium Chloride / Q000494:pharmacology; D013916:Thrombelastography / Q000662:veterinary
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D012462:Saline Solution, Hypertonic; D012965:Sodium Chloride; D005340:Fibrinogen
keywords: ROTEM; canine; colloids; dilutional coagulopathy; platelet function analyzer; thromboelastometry