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Article: In vivo effect of haemodilution with saline on coagulation: A randomized controlled trial

TitleIn vivo effect of haemodilution with saline on coagulation: A randomized controlled trial
Authors
KeywordsBlood, coagulation
Blood, haemodilution
Issue Date2002
PublisherOxford University Press. The Journal's web site is located at http://bja.oxfordjournals.org/
Citation
British Journal Of Anaesthesia, 2002, v. 88 n. 4, p. 475-480 How to Cite?
AbstractBackground. Previous studies have shown that 10-30% haemodilution with crystalloid may induce a hypercoagulable state demonstrable by using the Thrombelastograph® (TEG). While most are in vitro studies, the few in vivo studies are limited by confounding surgical or 'environmental' factors. We conducted this randomized controlled study to evaluate the coagulation changes associated with in vivo haemodilution. Methods. Twenty patients undergoing major hepatobiliary surgery were randomly allocated to one of two study groups. Group H (n=10) had 30% blood volume withdrawn over 30 min and replaced with saline. Group C (n=10) did not have any blood withdrawn. Blood samples were taken in both groups at 10, 20 and 30 min. Native TEG, complete blood count, coagulation profile, fibrinogen, antithrombin III, protein C and thrombin-antithrombin complex concentrations were measured. Results. Compared with Group C, Group H patients had significantly greater shortening of r-time at 30 min (-30% vs +36%), greater shortening of k-time at all time points (-36% vs + 17% at 10 min; -37% vs +44% at 20 min; -45% vs +49% at 30 min), and greater widening of α at 30 min (+71% vs +4%). The decrease in antithrombin III and other natural procoagulants and anti-coagulants closely followed that of haematocrit, with the exception of thrombin-antithrombin complex. Conclusion. In vivo haemodilution of up to 30% with saline can induce a hypercoagulable state. The mechanism remains unclear as disproportionate dilution of natural anticoagulants was not detected. Thrombin-antithrombin complex concentration remained stable despite haemodilution in Group H, which may suggest increased thrombin generation.
Persistent Identifierhttp://hdl.handle.net/10722/67297
ISSN
2015 Impact Factor: 5.616
2015 SCImago Journal Rankings: 2.314
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorNg, KFJen_HK
dc.contributor.authorLam, CCKen_HK
dc.contributor.authorChan, LCen_HK
dc.date.accessioned2010-09-06T05:53:44Z-
dc.date.available2010-09-06T05:53:44Z-
dc.date.issued2002en_HK
dc.identifier.citationBritish Journal Of Anaesthesia, 2002, v. 88 n. 4, p. 475-480en_HK
dc.identifier.issn0007-0912en_HK
dc.identifier.urihttp://hdl.handle.net/10722/67297-
dc.description.abstractBackground. Previous studies have shown that 10-30% haemodilution with crystalloid may induce a hypercoagulable state demonstrable by using the Thrombelastograph® (TEG). While most are in vitro studies, the few in vivo studies are limited by confounding surgical or 'environmental' factors. We conducted this randomized controlled study to evaluate the coagulation changes associated with in vivo haemodilution. Methods. Twenty patients undergoing major hepatobiliary surgery were randomly allocated to one of two study groups. Group H (n=10) had 30% blood volume withdrawn over 30 min and replaced with saline. Group C (n=10) did not have any blood withdrawn. Blood samples were taken in both groups at 10, 20 and 30 min. Native TEG, complete blood count, coagulation profile, fibrinogen, antithrombin III, protein C and thrombin-antithrombin complex concentrations were measured. Results. Compared with Group C, Group H patients had significantly greater shortening of r-time at 30 min (-30% vs +36%), greater shortening of k-time at all time points (-36% vs + 17% at 10 min; -37% vs +44% at 20 min; -45% vs +49% at 30 min), and greater widening of α at 30 min (+71% vs +4%). The decrease in antithrombin III and other natural procoagulants and anti-coagulants closely followed that of haematocrit, with the exception of thrombin-antithrombin complex. Conclusion. In vivo haemodilution of up to 30% with saline can induce a hypercoagulable state. The mechanism remains unclear as disproportionate dilution of natural anticoagulants was not detected. Thrombin-antithrombin complex concentration remained stable despite haemodilution in Group H, which may suggest increased thrombin generation.en_HK
dc.languageengen_HK
dc.publisherOxford University Press. The Journal's web site is located at http://bja.oxfordjournals.org/en_HK
dc.relation.ispartofBritish Journal of Anaesthesiaen_HK
dc.subjectBlood, coagulationen_HK
dc.subjectBlood, haemodilutionen_HK
dc.subject.meshAntithrombin III - metabolism-
dc.subject.meshBlood Coagulation-
dc.subject.meshDigestive System Neoplasms - surgery-
dc.subject.meshHemodilution-
dc.subject.meshIntraoperative Care-
dc.titleIn vivo effect of haemodilution with saline on coagulation: A randomized controlled trialen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0007-0912&volume=88&spage=475&epage=480&date=2002&atitle=In+vivo+effect+of+haemodilution+with+saline+on+coagulation:+a+randomised+controlled+trialen_HK
dc.identifier.emailNg, KFJ:jkfng@hkucc.hku.hken_HK
dc.identifier.emailChan, LC:chanlc@hkucc.hku.hken_HK
dc.identifier.authorityNg, KFJ=rp00544en_HK
dc.identifier.authorityChan, LC=rp00373en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1093/bja/88.4.475en_HK
dc.identifier.pmid12066721en_HK
dc.identifier.scopuseid_2-s2.0-0036204985en_HK
dc.identifier.hkuros67168en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036204985&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume88en_HK
dc.identifier.issue4en_HK
dc.identifier.spage475en_HK
dc.identifier.epage480en_HK
dc.identifier.isiWOS:000174851700004-
dc.publisher.placeUnited Kingdomen_HK

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