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[The effect of citrate or heparin coagulation on the dog's heart work in autotransfusion]
Insights
Massive autotransfusion impacts cardiac performance, especially with citrate anticoagulants. Heparinization offers a safer alternative, preserving heart function better during rapid blood transfusions.
Area of Science:
- Cardiovascular Physiology
- Transfusion Medicine
- Anesthesiology
Context:
- Massive autotransfusion is a critical procedure in veterinary medicine.
- Anticoagulation strategies significantly influence hemodynamic stability.
- Citrate-based anticoagulants are commonly used but can cause adverse effects.
Purpose:
- To investigate the impact of different anticoagulation methods on cardiac function during massive autotransfusion in dogs.
- To compare the effects of citrate-based (ACD, CPD) and heparin anticoagulation on cardiac work and performance.
- To elucidate the role of ionized calcium depletion in citrate-induced cardiac dysfunction.
Summary:
- Massive autotransfusion with citrate anticoagulants (ACD, CPD) led to significant transient decreases in cardiac parameters (up to 70%) in dogs, likely due to ionized calcium depletion.
- Heparin anticoagulation resulted in only a minor decrease (approx. 10%) in cardiac function.
- Simultaneous calcium administration abolished citrate's negative effects, confirming calcium depletion as the primary mechanism.
Impact:
- Heparinization appears preferable to citrate anticoagulation for maintaining cardiac performance during massive autotransfusion.
- Acid Citrate Dextrose (ACD) is favored over Citrate Phosphate Dextrose (CPD) when using citrate-based anticoagulants.
- Findings guide the selection of anticoagulation strategies to optimize patient outcomes in massive transfusion scenarios.
Abstract:
During massive autotransfusion in the dog, the different anticoagulation processes have an important influence on heart work and performance. This is especially marked with citrate, depending on the amount and the transfusion rate. In spite of normovolemia both parameters show a transient decrease up to 40% - 50% with ACD and up to 60% - 70% with CPD. These different reactions may be due to the corresponding composition of each stabilizer. The effect is abolished by simultaneous use of citrate and calcium, which may prove that the observed changes are caused mainly by a depletion of ionized calcium caused by the rapid transfusion. This is comparable to the well-known citrate intoxication. In contrast both cardiac parameters decrease only about 10% with heparin anticoagulation. Heparinization seems to be preferable to citrate as regards heart work and performance during massive autotransfusion. Also the two citrate stabilizers significantly differ in their effect on both cardiac parameters, the use of ACD being favoured.