Hextend attenuates hypercoagulability after severe liver injury in swine

S. Rob Todd, Darren Malinoski, Patrick J. Muller, Martin Schreiber, Stephen M. Cohn

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    Abstract

    Background: Hypercoagulability is a major source of morbidity and mortality after injury. A resuscitation regimen that modulates this coagulopathy may prove beneficial. We sought to evaluate the effects of lactated Ringer's (LR) solution and Hextend on the resuscitation of uncontrolled hemorrhagic shock. Methods: Twenty swine underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure and created a grade V liver injury. The annuals bled freely for 30 minutes, after which we measured the initial blood loss (that after injury). We blindly randomized the swine to receive LR solution or Hextend to achieve and maintain the baseline mean arterial pressure for 90 minutes postinjury. Laboratory values were obtained at baseline and on completion of the 2-hour study period. Results: The initial blood loss (before resuscitation) was 22 mL/kg in both treatment groups (p = 0.97). Animals required 119 ± 78 mL/kg of fluid in the LR group and 40 ± 21 mL/kg in the Hextend group (p = 0.01). After resuscitation, the secondary blood loss was 3.7 ± 1.7 mL/kg in the LR group and 4.7 ± 1.1 mL/kg in the Hextend group (p = 0.1). Thrombelastography revealed a hypercoagulable state in all animals after injury. This was less pronounced in those animals resuscitated with Hextend. Routine tests of coagulation did not reveal a hypercoagulable state. Conclusion: Modulation and restoration of normal coagulation is critical in the management of trauma patients. The patient's coagulation profile might determine the type of fluid to be used at various times during their course. Thrombelastography is superior to routine coagulation assays for the detection of a hypercoagulable state. Resuscitation with Hextend results in a decreased fluid requirement and attenuation of hypercoagulability after injury without increased blood loss.

    Original languageEnglish (US)
    Pages (from-to)589-594
    Number of pages6
    JournalJournal of Trauma - Injury, Infection and Critical Care
    Volume59
    Issue number3
    DOIs
    StatePublished - Sep 2005

    Fingerprint

    Thrombophilia
    Resuscitation
    Swine
    Liver
    Wounds and Injuries
    Thrombelastography
    Arterial Pressure
    Hemorrhagic Shock
    Splenectomy
    Morbidity
    Mortality
    Ringer's lactate

    Keywords

    • Coagulopathy
    • Hemorrhagic shock
    • Hextend
    • Lactated Ringer's (LR)
    • Resuscitation
    • Thrombelastography (TEG)
    • Trauma

    ASJC Scopus subject areas

    • Surgery

    Cite this

    Hextend attenuates hypercoagulability after severe liver injury in swine. / Todd, S. Rob; Malinoski, Darren; Muller, Patrick J.; Schreiber, Martin; Cohn, Stephen M.

    In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 3, 09.2005, p. 589-594.

    Research output: Contribution to journalArticle

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    abstract = "Background: Hypercoagulability is a major source of morbidity and mortality after injury. A resuscitation regimen that modulates this coagulopathy may prove beneficial. We sought to evaluate the effects of lactated Ringer's (LR) solution and Hextend on the resuscitation of uncontrolled hemorrhagic shock. Methods: Twenty swine underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure and created a grade V liver injury. The annuals bled freely for 30 minutes, after which we measured the initial blood loss (that after injury). We blindly randomized the swine to receive LR solution or Hextend to achieve and maintain the baseline mean arterial pressure for 90 minutes postinjury. Laboratory values were obtained at baseline and on completion of the 2-hour study period. Results: The initial blood loss (before resuscitation) was 22 mL/kg in both treatment groups (p = 0.97). Animals required 119 ± 78 mL/kg of fluid in the LR group and 40 ± 21 mL/kg in the Hextend group (p = 0.01). After resuscitation, the secondary blood loss was 3.7 ± 1.7 mL/kg in the LR group and 4.7 ± 1.1 mL/kg in the Hextend group (p = 0.1). Thrombelastography revealed a hypercoagulable state in all animals after injury. This was less pronounced in those animals resuscitated with Hextend. Routine tests of coagulation did not reveal a hypercoagulable state. Conclusion: Modulation and restoration of normal coagulation is critical in the management of trauma patients. The patient's coagulation profile might determine the type of fluid to be used at various times during their course. Thrombelastography is superior to routine coagulation assays for the detection of a hypercoagulable state. Resuscitation with Hextend results in a decreased fluid requirement and attenuation of hypercoagulability after injury without increased blood loss.",
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    T1 - Hextend attenuates hypercoagulability after severe liver injury in swine

    AU - Todd, S. Rob

    AU - Malinoski, Darren

    AU - Muller, Patrick J.

    AU - Schreiber, Martin

    AU - Cohn, Stephen M.

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    N2 - Background: Hypercoagulability is a major source of morbidity and mortality after injury. A resuscitation regimen that modulates this coagulopathy may prove beneficial. We sought to evaluate the effects of lactated Ringer's (LR) solution and Hextend on the resuscitation of uncontrolled hemorrhagic shock. Methods: Twenty swine underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure and created a grade V liver injury. The annuals bled freely for 30 minutes, after which we measured the initial blood loss (that after injury). We blindly randomized the swine to receive LR solution or Hextend to achieve and maintain the baseline mean arterial pressure for 90 minutes postinjury. Laboratory values were obtained at baseline and on completion of the 2-hour study period. Results: The initial blood loss (before resuscitation) was 22 mL/kg in both treatment groups (p = 0.97). Animals required 119 ± 78 mL/kg of fluid in the LR group and 40 ± 21 mL/kg in the Hextend group (p = 0.01). After resuscitation, the secondary blood loss was 3.7 ± 1.7 mL/kg in the LR group and 4.7 ± 1.1 mL/kg in the Hextend group (p = 0.1). Thrombelastography revealed a hypercoagulable state in all animals after injury. This was less pronounced in those animals resuscitated with Hextend. Routine tests of coagulation did not reveal a hypercoagulable state. Conclusion: Modulation and restoration of normal coagulation is critical in the management of trauma patients. The patient's coagulation profile might determine the type of fluid to be used at various times during their course. Thrombelastography is superior to routine coagulation assays for the detection of a hypercoagulable state. Resuscitation with Hextend results in a decreased fluid requirement and attenuation of hypercoagulability after injury without increased blood loss.

    AB - Background: Hypercoagulability is a major source of morbidity and mortality after injury. A resuscitation regimen that modulates this coagulopathy may prove beneficial. We sought to evaluate the effects of lactated Ringer's (LR) solution and Hextend on the resuscitation of uncontrolled hemorrhagic shock. Methods: Twenty swine underwent invasive line placement, midline celiotomy, and splenectomy. After a 15-minute stabilization period, we recorded a baseline mean arterial pressure and created a grade V liver injury. The annuals bled freely for 30 minutes, after which we measured the initial blood loss (that after injury). We blindly randomized the swine to receive LR solution or Hextend to achieve and maintain the baseline mean arterial pressure for 90 minutes postinjury. Laboratory values were obtained at baseline and on completion of the 2-hour study period. Results: The initial blood loss (before resuscitation) was 22 mL/kg in both treatment groups (p = 0.97). Animals required 119 ± 78 mL/kg of fluid in the LR group and 40 ± 21 mL/kg in the Hextend group (p = 0.01). After resuscitation, the secondary blood loss was 3.7 ± 1.7 mL/kg in the LR group and 4.7 ± 1.1 mL/kg in the Hextend group (p = 0.1). Thrombelastography revealed a hypercoagulable state in all animals after injury. This was less pronounced in those animals resuscitated with Hextend. Routine tests of coagulation did not reveal a hypercoagulable state. Conclusion: Modulation and restoration of normal coagulation is critical in the management of trauma patients. The patient's coagulation profile might determine the type of fluid to be used at various times during their course. Thrombelastography is superior to routine coagulation assays for the detection of a hypercoagulable state. Resuscitation with Hextend results in a decreased fluid requirement and attenuation of hypercoagulability after injury without increased blood loss.

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    KW - Hemorrhagic shock

    KW - Hextend

    KW - Lactated Ringer's (LR)

    KW - Resuscitation

    KW - Thrombelastography (TEG)

    KW - Trauma

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