title: Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran--a randomized controlled trial.
abstract: BACKGROUND
  Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.
  
  
  METHODS
  Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer's solution or Dextran 70 (Macrodex ®) that affects coagulation competence.
  
  
  RESULTS
  By thrombelastography evaluated coagulation competence, Dextran 70 reduced "maximal amplitude" (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer's group (P = 0.04).
  
  
  CONCLUSIONS
  With the use of Dextran 70 vs. lactated Ringer's solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.
  
  
  BACKGROUND
  The study was accepted on January 7(th), 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20.
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. dockcr@yahoo.com.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. dockcr@yahoo.com.|Department of Anesthesiology, Rigshospitalet 2043, Blegdamsvej 9, DK-2100, Copenhagen Ø, Denmark. dockcr@yahoo.com.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Rasmussen
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. michael.hoejskov@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. michael.hoejskov@regionh.dk.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoejskov
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. per.johansson@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. per.johansson@regionh.dk.
authors.forename: Per I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. irina.kridina@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. irina.kridina@regionh.dk.
authors.forename: Irina
authors.initials: I
authors.lastname: Kridina
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. thomas.kistrop@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. thomas.kistrop@regionh.dk.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kistorp
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. lisbeth.salling@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. lisbeth.salling@regionh.dk.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Salling
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. hening.bay@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. hening.bay@regionh.dk.
authors.forename: Henning B
authors.initials: HB
authors.lastname: Nielsen
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. birgitte.ruhnau@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. birgitte.ruhnau@regionh.dk.
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. doctp@yahoo.com.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. doctp@yahoo.com.
authors.forename: Tom
authors.initials: T
authors.lastname: Pedersen
authors.affiliation: Departments of Anesthesiology, Transfusion Medicine, University of Copenhagen, Copenhagen, Denmark. niels.secher@regionh.dk.|Departments of Urology and Centre for Head and Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. niels.secher@regionh.dk.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D015653:Cystectomy / Q000379:methods*; D003911:Dextrans / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D011446:Prospective Studies; D012044:Regression Analysis; D000077325:Ringer's Lactate; D013916:Thrombelastography / Q000379:methods
chemical_list: D003911:Dextrans; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077325:Ringer's Lactate