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Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery

Sigurjonsson, Johann LU ; Hedman, David; Bansch, Peter LU and Schött, Ulf LU (2018) In Perioperative medicine (London, England) 7(21).
Abstract (Swedish)
Background: Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the
main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran
could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental
study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand
function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and,
therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.
Methods: Eighteen patients undergoing major... (More)
Background: Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the
main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran
could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental
study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand
function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and,
therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.
Methods: Eighteen patients undergoing major gynaecological surgery were assigned to receive either 5% albumin or
6% dextran-70 with 9 patients in each group. Standard coagulation tests, including prothrombin time (PT), activated
partial thromboplastin time (aPTT), fibrinogen and platelet count, viscoelastic coagulation test thromboelastometry
(ROTEM) and the Multiplate platelet aggregation test were used to test for coagulation defects at different time points
perioperatively. Blood loss, blood loss replacement data and haemodynamic parameters were retrieved from
anaesthetic and postoperative charts. A local departmental fluid and transfusion/infusion protocol assured
haemoglobin > 90 g/l and mean arterial pressure > 65 mmHg with Ringer’s acetate in addition to the colloid use.
Results: There were no differences in demographic data between the groups. The tissue factor-activated
(EXTEM) clot-structure parameter ROTEM A10 was decreased significantly in the dextran group as compared
to the albumin group after the infusion of 500 ml of either colloid solution. The PT and aPTT were significantly
prolonged, and the platelet count decreased postoperatively in the dextran group, whereas albumin only deranged
fibrinogen levels as compared to preoperative levels. There were no differences in Multiplate platelet aggregometry,
amount of haemorrhage or transfusion of blood components between the groups.
Conclusions: Standard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are
affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies
should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran
and whether this affects haemostasis to a lesser degree. (Less)
Abstract
Background:

Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.
Methods:

Eighteen patients undergoing major gynaecological... (More)
Background:

Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.
Methods:

Eighteen patients undergoing major gynaecological surgery were assigned to receive either 5% albumin or 6% dextran-70 with 9 patients in each group. Standard coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and platelet count, viscoelastic coagulation test thromboelastometry (ROTEM) and the Multiplate platelet aggregation test were used to test for coagulation defects at different time points perioperatively. Blood loss, blood loss replacement data and haemodynamic parameters were retrieved from anaesthetic and postoperative charts. A local departmental fluid and transfusion/infusion protocol assured haemoglobin > 90 g/l and mean arterial pressure > 65 mmHg with Ringer's acetate in addition to the colloid use.
Results:

There were no differences in demographic data between the groups. The tissue factor-activated (EXTEM) clot-structure parameter ROTEM A10 was decreased significantly in the dextran group as compared to the albumin group after the infusion of 500 ml of either colloid solution. The PT and aPTT were significantly prolonged, and the platelet count decreased postoperatively in the dextran group, whereas albumin only deranged fibrinogen levels as compared to preoperative levels. There were no differences in Multiplate platelet aggregometry, amount of haemorrhage or transfusion of blood components between the groups.
Conclusions:

Standard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran and whether this affects haemostasis to a lesser degree. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Albumin, Blood-loss replacement, Dextran, Fluid therapy, Gynaecologic cancer, surgery
in
Perioperative medicine (London, England)
volume
7
issue
21
pages
11 pages
publisher
BioMed Central
external identifiers
  • pmid: 30202516
ISSN
2047-0525
DOI
10.1186/s13741-018-0100-0
language
English
LU publication?
yes
id
26a89bee-16b2-4c5a-a14e-33aa78fa0a43
date added to LUP
2018-09-07 11:32:41
date last changed
2018-11-21 21:41:30
@article{26a89bee-16b2-4c5a-a14e-33aa78fa0a43,
  abstract     = {Background:<br>
<br>
Hydroxyethyl starches have been withdrawn from the European market. In Sweden, dextran was the main colloid until 2000, when starches overtook the market. After the recent 6S-trial, it was suggested that dextran could be reinstituted, but concerns for greater coagulopathy, bleeding and anaphylaxis still remain. An experimental study from our department indicated that isovolemic substitution of dextran-70 did not derange the von Willebrand function more than albumin 5%, considering the fact that dextran is hyperoncotic in comparison to albumin 5% and, therefore, induces a greater plasma volume expansion and thereby a greater dilutional coagulopathy.<br>
Methods:<br>
<br>
Eighteen patients undergoing major gynaecological surgery were assigned to receive either 5% albumin or 6% dextran-70 with 9 patients in each group. Standard coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and platelet count, viscoelastic coagulation test thromboelastometry (ROTEM) and the Multiplate platelet aggregation test were used to test for coagulation defects at different time points perioperatively. Blood loss, blood loss replacement data and haemodynamic parameters were retrieved from anaesthetic and postoperative charts. A local departmental fluid and transfusion/infusion protocol assured haemoglobin &gt; 90 g/l and mean arterial pressure &gt; 65 mmHg with Ringer's acetate in addition to the colloid use.<br>
Results:<br>
<br>
There were no differences in demographic data between the groups. The tissue factor-activated (EXTEM) clot-structure parameter ROTEM A10 was decreased significantly in the dextran group as compared to the albumin group after the infusion of 500 ml of either colloid solution. The PT and aPTT were significantly prolonged, and the platelet count decreased postoperatively in the dextran group, whereas albumin only deranged fibrinogen levels as compared to preoperative levels. There were no differences in Multiplate platelet aggregometry, amount of haemorrhage or transfusion of blood components between the groups.<br>
Conclusions:<br>
<br>
Standard plasma-based coagulation tests, platelet count and whole blood viscoelastic clot structure are affected by 6% dextran-70 to a greater extent than by 5% albumin, but platelet aggregation is not. Future studies should use more advanced haemodynamic monitoring to assess isovolemic plasma volume expansion with dextran and whether this affects haemostasis to a lesser degree.},
  author       = {Sigurjonsson, Johann and Hedman, David and Bansch, Peter and Schött, Ulf},
  issn         = {2047-0525},
  keyword      = {Albumin,Blood-loss replacement,Dextran,Fluid therapy,Gynaecologic cancer,surgery},
  language     = {eng},
  month        = {09},
  number       = {21},
  pages        = {11},
  publisher    = {BioMed Central},
  series       = {Perioperative medicine (London, England)},
  title        = {Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery},
  url          = {http://dx.doi.org/10.1186/s13741-018-0100-0},
  volume       = {7},
  year         = {2018},
}