Sibylle A Kozek-Langenecker1. 1. aSigmund Freud Private University Vienna bDepartment of Anesthesia and Intensive Care, Evangelical Hospital Vienna, Vienna, Austria.
Abstract
PURPOSE OF REVIEW: Infusion therapy is essential in intravascular hypovolaemia and extravascular fluid deficits. Crystalloidal fluids and colloidal volume replacement affect blood coagulation when infused intravenously. The question remains if this side-effect of infusion therapy is clinically relevant in patients with and without bleeding manifestations, and if fluid-induced coagulopathy is a risk factor for anaemia, blood transfusion, and mortality, and a driver for resource use and costs. RECENT FINDINGS: Pathomechanisms of dilutional coagulopathy and evidence for its clinical relevance in perioperative and critically ill patients are reviewed. Furthermore, the article discusses medicolegal aspects. SUMMARY: The dose-dependent risk of dilutional coagulopathy differs between colloids (dextran > hetastarch > pentastarch > tetrastarch, gelatins > albumin). Risk awareness includes monitoring for early signs of side-effects. With rotational thromboelastometry/thrombelastography, the deterioration not only in clot strength but also in clot formation and in platelet interaction can be assessed. Fibrinogen concentrate administration may be considered in severe bleeding as well as relevant dilutional coagulopathy. Targeted doses of gelatins and tetrastarches seem to have no proven adverse effect on anaemia and allogeneic blood transfusions. Further studies are needed.
PURPOSE OF REVIEW: Infusion therapy is essential in intravascular hypovolaemia and extravascular fluid deficits. Crystalloidal fluids and colloidal volume replacement affect blood coagulation when infused intravenously. The question remains if this side-effect of infusion therapy is clinically relevant in patients with and without bleeding manifestations, and if fluid-induced coagulopathy is a risk factor for anaemia, blood transfusion, and mortality, and a driver for resource use and costs. RECENT FINDINGS: Pathomechanisms of dilutional coagulopathy and evidence for its clinical relevance in perioperative and critically illpatients are reviewed. Furthermore, the article discusses medicolegal aspects. SUMMARY: The dose-dependent risk of dilutional coagulopathy differs between colloids (dextran > hetastarch > pentastarch > tetrastarch, gelatins > albumin). Risk awareness includes monitoring for early signs of side-effects. With rotational thromboelastometry/thrombelastography, the deterioration not only in clot strength but also in clot formation and in platelet interaction can be assessed. Fibrinogen concentrate administration may be considered in severe bleeding as well as relevant dilutional coagulopathy. Targeted doses of gelatins and tetrastarches seem to have no proven adverse effect on anaemia and allogeneic blood transfusions. Further studies are needed.
Authors: Felipe Maia de Toledo Piza; Thiago Domingos Corrêa; Alexandre Rodrigues Marra; João Carlos Campos Guerra; Roseny Dos Reis Rodrigues; Andrea Aparecida Rocco Villarinho; Valdir Fernandes de Aranda; Sandra Christina Pereira Lima Shiramizo; Maria Roza de Jesus de Lima; Esper Georges Kallas; Alexandre Biasi Cavalcanti Journal: BMC Infect Dis Date: 2017-01-19 Impact factor: 3.090