Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial

Kirsten Cleemann Rasmussen; Michael Hoejskov; Pär I. Johansson; Irina Kridina; Thomas Kistorp; Lisbeth Salling; Henning  M. Bay  Nielsen; Birgitte Ruhnau; Tom Pedersen; Niels H Secher

doi:10.1186/s12871-015-0162-1

Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial

Kirsten Cleemann Rasmussen, Michael Hoejskov, Pär I. Johansson, Irina Kridina, Thomas Kistorp, Lisbeth Salling, Henning M. Bay Nielsen, Birgitte Ruhnau, Tom Pedersen, Niels H Secher

14 Citations (Scopus)

Abstract

BACKGROUND: Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.

METHODS: Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer's solution or Dextran 70 (Macrodex ®) that affects coagulation competence.

RESULTS: By thrombelastography evaluated coagulation competence, Dextran 70 reduced "maximal amplitude" (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer's group (P = 0.04).

CONCLUSIONS: With the use of Dextran 70 vs. lactated Ringer's solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.

TRIAL REGISTRATION: The study was accepted on January 7(th), 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20 .

Original language	English
Journal	B M C Anesthesiology
Volume	15
Pages (from-to)	178
Number of pages	8
ISSN	1471-2253
DOIs	https://doi.org/10.1186/s12871-015-0162-1
Publication status	Published - 2015

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10.1186/s12871-015-0162-1

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Rasmussen, K. C., Hoejskov, M., Johansson, P. I., Kridina, I., Kistorp, T., Salling, L., Nielsen, H. M. B., Ruhnau, B., Pedersen, T., & Secher, N. H. (2015). Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial. B M C Anesthesiology, 15, 178. https://doi.org/10.1186/s12871-015-0162-1

@article{c573eec167524a5ba99c9744716a65b8,

title = "Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial",

abstract = "BACKGROUND: Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.METHODS: Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer's solution or Dextran 70 (Macrodex {\textregistered}) that affects coagulation competence.RESULTS: By thrombelastography evaluated coagulation competence, Dextran 70 reduced {"}maximal amplitude{"} (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer's group (P = 0.04).CONCLUSIONS: With the use of Dextran 70 vs. lactated Ringer's solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.TRIAL REGISTRATION: The study was accepted on January 7(th), 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20 .",

author = "Rasmussen, {Kirsten Cleemann} and Michael Hoejskov and Johansson, {P{\"a}r I.} and Irina Kridina and Thomas Kistorp and Lisbeth Salling and Nielsen, {Henning M. Bay} and Birgitte Ruhnau and Tom Pedersen and Secher, {Niels H}",

year = "2015",

doi = "10.1186/s12871-015-0162-1",

language = "English",

volume = "15",

pages = "178",

journal = "BMC Anesthesiology",

issn = "1471-2253",

publisher = "BioMed Central Ltd",

}

TY - JOUR

T1 - Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial

AU - Rasmussen, Kirsten Cleemann

AU - Hoejskov, Michael

AU - Johansson, Pär I.

AU - Kridina, Irina

AU - Kistorp, Thomas

AU - Salling, Lisbeth

AU - Nielsen, Henning M. Bay

AU - Ruhnau, Birgitte

AU - Pedersen, Tom

AU - Secher, Niels H

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.METHODS: Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer's solution or Dextran 70 (Macrodex ®) that affects coagulation competence.RESULTS: By thrombelastography evaluated coagulation competence, Dextran 70 reduced "maximal amplitude" (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer's group (P = 0.04).CONCLUSIONS: With the use of Dextran 70 vs. lactated Ringer's solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.TRIAL REGISTRATION: The study was accepted on January 7(th), 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20 .

AB - BACKGROUND: Perioperative hemorrhage may depend on coagulation competence and this study evaluated the influence of coagulation competence on blood loss during cystectomy due to bladder cancer.METHODS: Forty patients undergoing radical cystectomy were included in a randomized controlled trial to receive either lactated Ringer's solution or Dextran 70 (Macrodex ®) that affects coagulation competence.RESULTS: By thrombelastography evaluated coagulation competence, Dextran 70 reduced "maximal amplitude" (MA) by 25 % versus a 1 % reduction with the administration of lactated Ringer's solution (P <0.001). Blinded evaluation of the blood loss was similar in the two groups of patients - 2339 ml with the use of Dextran 70 and 1822 ml in the lactated Ringer's group (P = 0.27). Yet, the blood loss was related to the reduction in MA (r = -0.427, P = 0.008) and by multiple regression analysis independently associated with MA (P = 0.01). Thus, 11 patients in the dextran group (58 %) developed a clinical significant blood loss (>1500 ml) compared to only four patients (22 %) in the lactated Ringer's group (P = 0.04).CONCLUSIONS: With the use of Dextran 70 vs. lactated Ringer's solution during cystectomy, a relation between hemorrhage and coagulation competence is demonstrated. Significant bleeding develops based on an about 25 % reduction in thrombelastography determined maximal amplitude. A multivariable model including maximal amplitude discriminates patients with severe perioperative bleeding during cystectomy.TRIAL REGISTRATION: The study was accepted on January 7(th), 2013 at www.clinicaltrialsregister.eu EudraCT 2012-005040-20 .

U2 - 10.1186/s12871-015-0162-1

DO - 10.1186/s12871-015-0162-1

M3 - Journal article

C2 - 26646213

VL - 15

SP - 178

JO - BMC Anesthesiology

JF - BMC Anesthesiology

SN - 1471-2253

ER -

Coagulation competence for predicting perioperative hemorrhage in patients treated with lactated Ringer's vs. Dextran - a randomized controlled trial

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