1.
Albumin induced hypercoagulability does not reduce blood loss in patients undergoing total hip arthroplasty
Niemi TT, Silvanto M, Rosenberg PH
Scandinavian Journal of Surgery. 2005;94((3):):227-32.
Abstract
Background and Aims: Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients. Material and Methods: 101 patients undergoing primary hip arthroplasty received in random order 4% albumin (n = 48) or HES (average Mw 120 kDa/molar substitution ratio 0. 7, n = 53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6-8%, 12-16%, 60% and 100% blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis. Results and Conclusions: Administration of albumin or HES 1200 ml (500-2000 and 500-1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0. 04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0. 001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.
2.
Thrombelastogram reveals hypercoagulability after administration of gelatin solution
Karoutsos S, Nathan N, Lahrimi A, Grouille D, Feiss P, Cox DJ
British Journal of Anaesthesia. 1999;82((2):):175-7.
Abstract
We have compared the effects of gelatin, low molecular weight hydroxyethyl starch (HES) or albumin on tests of haemostasis and on the thrombelastogram in 42 ASA I patients undergoing total hip or knee replacement. Patients were allocated randomly to receive one of the three blood substitutes to obtain moderate intraoperative haemodilution. Blood loss and packed red cell infusion was the same in each group. A greater amount of gelatin was given (1.5 times the measured blood loss) because of its shorter half-life. There was a statistically significant but clinically negligible decrease in platelets count, prothrombin time and fibrinogen, and an increase in bleeding time in all groups. Platelets were slightly but significantly lower after HES. Haemodilution was comparable between groups. TEG showed a state of hypercoagulability in the gelatin group with a significant decrease in r, r + k and an increase in alpha angle.
3.
Comparison of effects of Elohes and albumin on hemostasis in orthopedic surgery French
Rosencher N, Vassilieff N, Guigonis V, Toulon P, Conseiller C
Annales Francaises d Anesthesie et de Reanimation. 1992;11((5):):526-30.
Abstract
A prospective study was carried out to determine the effects of Elohes, a low molecular weight hydroxyethylstarch, on haemostasis. Sixteen patients due to undergo total hip replacement were randomly assigned to one of two groups: group A, who were to receive up to 21 of 4% albumin to replace blood loss, and group E, 1.51 of Elohes. Patients were then given concentrated red cell packs (RCP) and lactated Ringer's solution so as to have a haematocrit value of 30%, up to the fifth postoperative day. The amount of blood lost intraoperatively was calculated by weighing the swabs and measuring the volume aspirated. Haemostasis was investigated on the eve of surgery, 3 hours afterwards, and then every second day (days 1, 3 and 5). Total blood loss and the number of RCP transfused were similar in both groups: 1,517 +/- 425 ml and 3.5 RCP, and 1,428 +/- 250 ml and 3.25 RCP in groups A and E respectively. Blood albumin concentrations fell in group E as expected, the starch diluting blood proteins. Bleeding time (Simplate), activated partial thromboplastin time, prothrombin time changed in the same way in both groups throughout the study period after infusion of either Elohes or albumin. The concentrations in factors II, V, VII and X fell by 30% three hours after surgery. Values returned to normal between days 1 and 3, the concentrations of some factors rising to values greater than preoperative values because of the postoperative inflammatory process (fibrinogen, factor VIII von Willebrand). However, there were no significant differences between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)
4.
Volume substitution in acute normovolemic hemodilution. 5% human albumin vs. 6% hydroxyethyl starch . German
von Bormann B, Sticher J, Ratthey K, Idelberger R, Hempelmann G
Infusionstherapie (Basel). 1990;17((3):):142-6.
Abstract
In order to ascertain the hemodynamic and biochemic effect of different colloid solutions, 60 patients scheduled for hip arthroplasty were randomly divided into two groups. Prior to surgery, acute normovolemic hemodilution was performed by withdrawal of 15 ml blood/kg bodyweight and simultaneous compensation using either 5% human albumine (HA) or 6% hydroxyethylstarch (200/0.5) (HAES), each group consisting of 30 patients. During and after the operation a decrease of hemoglobin-levels to 8 g% was accepted before autologous plus (if necessary) homologous blood was applied. Neither hemodilution nor tolerance of normovolemic anemia during the intra- and postoperative period had any negative effects on clinical course. Hemodynamics kept stable, no disorders of coagulation were observed. In addition lactate levels as well as histamin values remained within normal range during the whole investigation period (until the 10th postoperative day). There were no significant differences between the two groups; only histamine levels after albumin were up to 2.2 as high as after HAES. Colloid consumption at the day of operation was on the average 2.6 l/patient x day (HAES) and 3.11 (albumin) respectively. Colloidosmotic pressure remained constant in both groups and seemed to be independent from the kind of volume therapy. The present data demonstrate that normovolemic anemia can be tolerated during the perioperative period even when large amounts of colloid infusion are applied. HAES is an less expensive but adequate colloid solution compared to albumin.