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Thrombelastogram reveals hypercoagulability after administration of gelatin solution
S Karoutsos1, N Nathan, A Lahrimi
1Department of Anaesthesia, CHU Dupuytren, Limoges, France.
British Journal of Anaesthesia
|June 12, 1999
Summary
Gelatin, hydroxyethyl starch (HES), and albumin were compared for their effects on hemostasis during surgery. Gelatin administration resulted in hypercoagulability, indicated by thrombelastogram changes.
Area of Science:
- Anesthesiology
- Hematology
- Surgical Hemostasis
Background:
- Intraoperative hemodilution is common during major orthopedic surgery.
- Blood substitutes like gelatin, HES, and albumin are used to manage hemodilution.
- Their comparative effects on hemostasis require detailed investigation.
Purpose of the Study:
- To compare the hemostatic effects of gelatin, low molecular weight hydroxyethyl starch (HES), and albumin.
- To evaluate thrombelastogram (TEG) changes in patients receiving these colloids.
- To assess clinical relevance of observed hemostatic alterations.
Main Methods:
- Randomized controlled trial in 42 ASA I patients undergoing hip or knee replacement.
- Administration of gelatin, HES, or albumin to achieve moderate intraoperative hemodilution.
- Analysis of hemostasis tests and thrombelastogram (TEG) parameters.
Main Results:
- All groups showed statistically significant but clinically negligible decreases in platelets, prothrombin time, and fibrinogen, with increased bleeding time.
- Hydroxyethyl starch (HES) led to a slight but significant decrease in platelet count.
- Thrombelastogram (TEG) indicated hypercoagulability in the gelatin group, with decreased r and r+k values and an increased alpha angle.
Conclusions:
- Gelatin, HES, and albumin cause comparable hemodilution with minor hemostatic alterations.
- Gelatin administration may induce a hypercoagulable state, as evidenced by TEG findings.
- Clinical significance of these hemostatic changes requires further study.