| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Received from the Department of Anesthesiology, Rush-Presbyterian-St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, Illinois.
Abstract
The effects of progressive blood loss on coagulation were studied in 87 adults (age 23–66 yr) undergoing a variety of operations under general anesthesia. None had preoperative alterations in coagulation or liver function and none were receiving anticoagulant or antiplatelet medication. Whole blood coagulation status was quantitated using thrombelastography (TEG). Blood samples for TEG were obtained 5 min before and 15 min after induction of anesthesia, after each increment of blood loss (EBL) equalling 5% of estimated blood volume (EBV), at the end of surgery, and 2 hr postoperatively. Patients with EBL exceeding 0.15 EBV were given packed red cells and crystalloid solution. Patients with EBL less than 0.15 EBV received only crystalloid. Thrombelastography analysis showed a trend toward increased coagulability with progressive blood loss. Two of four patients with 80% loss of EBV maintained normal to enhanced coagulation status, although the other two developed clinical and thrombelastographic evidence of coagulopathy. Thrombelastography allowed rapid intraoperative diagnosis and specific treatment of loss of platelet activity in the latter two patients. We conclude that during moderate to massive blood loss, use of supplemental fresh frozen plasma and/or platelets should be reserved for patients with documented defects in coagulation. Thrombelastography is useful for the detection and management of coagulation defects associated with intraoperative blood loss.
Key Words: BLOOD, Coagulation-thrombelastography
This article has been cited by other articles:
|
|
 |
|
  J.-F. Hardy, P. de Moerloose, C. M. Samama, and Members of the Groupe d'Interet en Hemostase Perio Massive transfusion and coagulopathy: pathophysiology and implications for clinical management: [Transfusion massive et coagulopathie-: physiopathologie et implications cliniques]. Can J Anesth, June 1, 2006; 53(6_suppl): S40 - S58. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. G. Nielsen, R. T. Lyerly III, and W. Q. Gurley The Effect of Dilution on Plasma Coagulation Kinetics Determined by Thrombelastography Is Dependent on Antithrombin Activity and Mode of Activation Anesth. Analg., December 1, 2004; 99(6): 1587 - 1592. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Miller, S. R. Tosone, N. A. Guzzetta, J. L. Miller, and K. K. Brosius Fibrinogen in Children Undergoing Cardiac Surgery: Is It Effective? Anesth. Analg., November 1, 2004; 99(5): 1341 - 1346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-F. Hardy, P. de Moerloose, M. Samama, and members of the Groupe d'interet en Hemostase Perio Massive transfusion and coagulopathy: pathophysiology and implications for clinical management: [Transfusion massive et coagulopathie : physiopathologie et implications cliniques] Can J Anesth, April 1, 2004; 51(4): 293 - 310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. H. Kuitunen, M. J. Hynynen, E. Vahtera, and M. T. Salmenpera Hydroxyethyl Starch as a Priming Solution for Cardiopulmonary Bypass Impairs Hemostasis After Cardiac Surgery Anesth. Analg., February 1, 2004; 98(2): 291 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. E. Miller, N. A. Guzzetta, S. R. Tosone, J. L. Miller, A. R. Flunker, E. M. Silvey, and J. H. Levy Tissue Factor-Activated Thromboelastograms in Children Undergoing Cardiac Surgery: Baseline Values and Comparisons Anesth. Analg., November 1, 2003; 97(5): 1289 - 1293. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Roche and M. F. James Watering down the clots, or are we? Trauma, October 1, 2003; 5(4): 235 - 244. [Abstract] [PDF]
|
|
|
|
|
|
T. Ruttmann and V. G. Nielsen Hemodilution-Induced Hypercoagulability * Response Anesth. Analg., May 1, 2003; 96(5): 1539 - 1540. [Full Text] [PDF]
|
|
|
|
 |
|
 V. A. Bowbrick, D. P. Mikhailidis, and G. Stansby Value of Thromboelastography in the Assessment of Platelet Function Clinical and Applied Thrombosis/Hemostasis, April 1, 2003; 9(2): 137 - 142. [Abstract] [PDF]
|
|
|
|
|
|
S. B. Jones, C. W. Whitten, G. J. Despotis, and T. G. Monk The Influence of Crystalloid and Colloid Replacement Solutions in Acute Normovolemic Hemodilution: A Preliminary Survey of Hemostatic Markers Anesth. Analg., February 1, 2003; 96(2): 363 - 368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T. McCammon, J. P. Wright, M. Figueroa, and V. G. Nielsen Hemodilution with Albumin, but Not Hextend(R), Results in Hypercoagulability as Assessed by Thrombelastography(R) in Rabbits: Role of Heparin-Dependent Serpins and Factor VIII Complex Anesth. Analg., October 1, 2002; 95(4): 844 - 850. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. G. Ruttmann, M. F. M. James, and J. Finlayson Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery{dagger} Br. J. Anaesth., August 1, 2002; 89(2): 226 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Fries, P. Innerhofer, A. Klingler, U. Berresheim, M. Mittermayr, A. Calatzis, and W. Schobersberger The Effect of the Combined Administration of Colloids and Lactated Ringer's Solution on the Coagulation System: An In Vitro Study Using Thrombelastograph(R) Coagulation Analysis (ROTEG(R)) Anesth. Analg., May 1, 2002; 94(5): 1280 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. G. Ruttmann Editorial II: Haemodilution enhances coagulation Br. J. Anaesth., April 1, 2002; 88(4): 470 - 472. [Full Text] [PDF]
|
|
|
|
|
|
V. G. Nielsen Resuscitation with Hextend(R) Decreases Endogenous Circulating Heparin Activity and Accelerates Clot Initiation After Hemorrhage in the Rabbit Anesth. Analg., November 1, 2001; 93(5): 1106 - 1110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Forestier, S. Belisle, C. Contant, F. Harel, G. Janvier, and J.-F. Hardy Reproductibilite et interchangeabilite du Thromboelastographe(R), Sonoclot(R) et du temps de coagulation active (Hemochron(R)), en chirurgie cardiaque : [Reproducibility and interchangeability of the Thromboelastograph(R), Sonoclot(R) and Hemochron(R) activated coagulation time in cardiac surgery] Can J Anesth, October 1, 2001; 48(9): 902 - 910. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. F. Glidden, C. Malaska, and S. W. Herring Thromboelastograph Assay for Measuring the Mechanical Strength of Fibrin Sealant Clots Clinical and Applied Thrombosis/Hemostasis, October 1, 2000; 6(4): 226 - 233. [Abstract] [PDF]
|
|
|
|
|
|
G. A. Petroianu, J. Liu, W. H. Maleck, C. Mattinger, and W. F. Bergler The Effect of In Vitro Hemodilution with Gelatin, Dextran, Hydroxyethyl Starch, or Ringer’s Solution on Thrombelastograph(R) Anesth. Analg., April 1, 2000; 90(4): 795 - 800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Konrad, T. J. Markl, G. K. Schuepfer, J. Schmeck, and H. R. Gerber In Vitro Effects of Different Medium Molecular Hydroxyethyl Starch Solutions and Lactated Ringer’s Solution on Coagulation Using SONOCLOT Anesth. Analg., February 1, 2000; 90(2): 274 - 274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Konrad, T. Markl, G. Schuepfer, H. Gerber, and M. Tschopp The Effects of In Vitro Hemodilution with Gelatin, Hydroxyethyl Starch, and Lactated Ringer’s Solution on Markers of Coagulation: An Analysis Using SONOCLOTTM Anesth. Analg., March 1, 1999; 88(3): 483 - 483. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Robbins, M. Forrest, and D. Royston Hypercoagulable States Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 295 - 318. [Abstract] [PDF]
|
|
|
|
|
|
G. A. Egli and D. R. Spahn Does Hemodilution Enhance or Compromise Blood Coagulation? Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 342 - 348. [Abstract] [PDF]
|
|
|
|
|
|
D. Royston Hemostatic Drugs in Prothrombotic or Hypercoagulable States Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 1997; 1(4): 376 - 394. [Abstract] [PDF]
|
|
|
