Impairment of coagulation by commonly used resuscitation fluids in human volunteers

Background

This study compared the effects of two commonly used resuscitation fluids on whole blood coagulation.

Methods

1000 ml of two resuscitation fluids each (saline and Gelofusine) were given to eight volunteers in a crossover design with a 2‐week washout period. The effect on whole blood coagulation was assessed using the Sonoclot analyzer, a conventional coagulation screen and coagulation markers.

Results

No significant effect was found on whole blood coagulation by giving saline (time to peak clot increased by a mean of 106 s; (95% confidence interval (CI) –140 to 354), whereas Gelofusine delayed the time to peak by a mean of 845 s (95% CI 435 to 1255). By contrast, there was no change in the conventional coagulation screen with either fluid.

Conclusion

It was concluded that some resuscitation fluids have an effect on clot formation that is not shown by the conventional coagulation screen, but is disclosed only if the whole coagulation process is studied.There is an ongoing controversy about the relative merits of different types of resuscitation fluid.¹ In this discussion, the effects of different fluids on coagulation is rarely mentioned, despite coagulopathy often being a problem after large‐volume fluid resuscitation. The origin of this coagulopathy is multifactorial,² and it is usually assumed that resuscitation fluids contribute by cooling the patient and diluting clotting factors. However, there may also be a direct effect owing to an interaction between resuscitation fluid molecules and the coagulation system.Using whole blood coagulation analysis, we have already found a wide variation in the in vitro effects of resuscitation fluids on coagulation, with no simple crystalloid or colloid difference.³ We know that in vitro 0.9% saline has a procoagulant effect at lower dilutions and an anticoagulant effect at higher dilutions, and that Gelofusine has a marked anticoagulant effect.⁴ If this direct effect of a resuscitation fluid on coagulation was also present in vivo, it would influence the choice of fluid given to the bleeding patient in emergency care. This study compares the effects of saline and Gelofusine on whole blood coagulation in human volunteers.