title: Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial.
abstract: For patients exposed to a massive blood loss during surgery, maintained coagulation competence is important. It is less obvious whether coagulation competence influences bleeding during elective surgery where patients are exposed to infusion of a crystalloid or a colloid. This randomized controlled trial evaluates whether administration of 5% human albumin (HA) or lactated Ringer solution (LR) affects coagulation competence and in turn blood loss during cystectomy due to bladder cancer. Forty patients undergoing radical cystectomy were included to receive either 5% HA (n = 20) or LR (n = 20). Nineteen patients were analyzed in the HA group and 20 patients in the lactated Ringer group. Blinded determination of the blood loss was similar in the 2 groups of patients: 1658 (800-3300) mL with the use of HA and 1472 (700-4330) mL in the lactated Ringer group (P = 0.45). Yet, by thrombelastography (TEG) evaluated coagulation competence, albumin affected clot growth (TEG-angle 69 ± 5 vs 74° ± 3°, P < 0.01) and strength (TEG-MA: 59 ± 6 vs 67 ± 6 mm, P < 0.001) more than LR. Furthermore, by multivariate linear regression analyses reduced TEG-MA was independently associated with the blood loss (P = 0.042) while administration of albumin was related to the changes in TEG-MA (P = 0.029), aPPT (P < 0.022), and INR (P < 0.033). This randomized controlled trial demonstrates that administration of HA does not affect the blood loss as compared to infusion of LR. Also the use of HA did not affect the need for blood transfusion, the incidence of postoperative complications, or the hospital in-stay. Yet, albumin decreases coagulation competence during major surgery and the blood loss is related to TEG-MA rather than to plasma coagulation variables.
authors.affiliation: From the Department of Anesthesiology (KCR, MH, IK, TK, HBN, BR, NHS); Department of Urology (LS); Center of Head and Orthopaedic Surgery (TP); Rigshospitalet, University of Copenhagen; Department of Transfusion Medicine, Rigshospitalet and Department of Surgery, Denmark, and University of Texas Health Medical School, Houston, TX, USA (PIJ).
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Rasmussen
authors.forename: Michael
authors.initials: M
authors.lastname: Højskov
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.forename: Irina
authors.initials: I
authors.lastname: Kridina
authors.forename: Thomas
authors.initials: T
authors.lastname: Kistorp
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Salling
authors.forename: Henning B
authors.initials: HB
authors.lastname: Nielsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Ruhnau
authors.forename: Tom
authors.initials: T
authors.lastname: Pedersen
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006401:Hematologic Agents / Q000008:administration & dosage; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage*; D008297:Male; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control; D000077325:Ringer's Lactate; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D006401:Hematologic Agents; D007552:Isotonic Solutions; D000077325:Ringer's Lactate