Journal
BEST PRACTICE & RESEARCH-CLINICAL ANAESTHESIOLOGY
Volume 23, Issue 2, Pages 225-236Publisher
ELSEVIER SCIENCE BV
DOI: 10.1016/j.bpa.2008.11.002
Keywords
hydroxyethyl starch; gelatin; dextran; albumin; crystalloid; sepsis-associated coagulopathy; trauma-induced coagulopathy; hypercoagulability; platelet function; coagulation factors; fibrin polymerization; fibrinolysis
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Haemostatic alterations associated with the use of fluids are related to non-specific dilutional effects and colloid-specific effects, such as acquired von Willebrand syndrome, inhibition of platelet function and fibrin polymerization. Judging by currently available evidence, dextran, hetastarch and pentastarch have a more pronounced impact than tetrastarch, gelatin and albumin. In patients with hypocoagulability, tetrastarch appears to be a suitable volume expander due to its high safety index and volume efficacy. Gelatins have lower inhibitory effects on clot strength compared with tetrastarch, but their volume efficacy is also lower. Dextrans are potent anticoagulants with a high risk for adverse reactions. Albumin has negligible effects on haemostasis, but low volume efficacy and costs limit the use of a blood product as a routine volume replacement fluid. To avoid potential acidosisinduced changes in haemostasis, plasma-adapted carrier solutions may be used instead of saline-based solutions. (C) 2008 Elsevier Ltd. All rights reserved.
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