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Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial

For patients exposed to a massive blood loss during surgery, maintained coagulation competence is important. It is less obvious whether coagulation competence influences bleeding during elective surgery where patients are exposed to infusion of a crystalloid or a colloid. This randomized controlled...

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Autores principales: Rasmussen, Kirsten C., Højskov, Michael, Johansson, Pär I., Kridina, Irina, Kistorp, Thomas, Salling, Lisbeth, Nielsen, Henning B., Ruhnau, Birgitte, Pedersen, Tom, Secher, Niels H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782842/
https://www.ncbi.nlm.nih.gov/pubmed/26945358
http://dx.doi.org/10.1097/MD.0000000000002720
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author Rasmussen, Kirsten C.
Højskov, Michael
Johansson, Pär I.
Kridina, Irina
Kistorp, Thomas
Salling, Lisbeth
Nielsen, Henning B.
Ruhnau, Birgitte
Pedersen, Tom
Secher, Niels H.
author_facet Rasmussen, Kirsten C.
Højskov, Michael
Johansson, Pär I.
Kridina, Irina
Kistorp, Thomas
Salling, Lisbeth
Nielsen, Henning B.
Ruhnau, Birgitte
Pedersen, Tom
Secher, Niels H.
author_sort Rasmussen, Kirsten C.
collection PubMed
description For patients exposed to a massive blood loss during surgery, maintained coagulation competence is important. It is less obvious whether coagulation competence influences bleeding during elective surgery where patients are exposed to infusion of a crystalloid or a colloid. This randomized controlled trial evaluates whether administration of 5% human albumin (HA) or lactated Ringer solution (LR) affects coagulation competence and in turn blood loss during cystectomy due to bladder cancer. Forty patients undergoing radical cystectomy were included to receive either 5% HA (n = 20) or LR (n = 20). Nineteen patients were analyzed in the HA group and 20 patients in the lactated Ringer group. Blinded determination of the blood loss was similar in the 2 groups of patients: 1658 (800–3300) mL with the use of HA and 1472 (700–4330) mL in the lactated Ringer group (P = 0.45). Yet, by thrombelastography (TEG) evaluated coagulation competence, albumin affected clot growth (TEG-angle 69 ± 5 vs 74° ± 3°, P < 0.01) and strength (TEG-MA: 59 ± 6 vs 67 ± 6 mm, P < 0.001) more than LR. Furthermore, by multivariate linear regression analyses reduced TEG-MA was independently associated with the blood loss (P = 0.042) while administration of albumin was related to the changes in TEG-MA (P = 0.029), aPPT (P < 0.022), and INR (P < 0.033). This randomized controlled trial demonstrates that administration of HA does not affect the blood loss as compared to infusion of LR. Also the use of HA did not affect the need for blood transfusion, the incidence of postoperative complications, or the hospital in-stay. Yet, albumin decreases coagulation competence during major surgery and the blood loss is related to TEG-MA rather than to plasma coagulation variables.
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spelling pubmed-47828422016-03-24 Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial Rasmussen, Kirsten C. Højskov, Michael Johansson, Pär I. Kridina, Irina Kistorp, Thomas Salling, Lisbeth Nielsen, Henning B. Ruhnau, Birgitte Pedersen, Tom Secher, Niels H. Medicine (Baltimore) 3300 For patients exposed to a massive blood loss during surgery, maintained coagulation competence is important. It is less obvious whether coagulation competence influences bleeding during elective surgery where patients are exposed to infusion of a crystalloid or a colloid. This randomized controlled trial evaluates whether administration of 5% human albumin (HA) or lactated Ringer solution (LR) affects coagulation competence and in turn blood loss during cystectomy due to bladder cancer. Forty patients undergoing radical cystectomy were included to receive either 5% HA (n = 20) or LR (n = 20). Nineteen patients were analyzed in the HA group and 20 patients in the lactated Ringer group. Blinded determination of the blood loss was similar in the 2 groups of patients: 1658 (800–3300) mL with the use of HA and 1472 (700–4330) mL in the lactated Ringer group (P = 0.45). Yet, by thrombelastography (TEG) evaluated coagulation competence, albumin affected clot growth (TEG-angle 69 ± 5 vs 74° ± 3°, P < 0.01) and strength (TEG-MA: 59 ± 6 vs 67 ± 6 mm, P < 0.001) more than LR. Furthermore, by multivariate linear regression analyses reduced TEG-MA was independently associated with the blood loss (P = 0.042) while administration of albumin was related to the changes in TEG-MA (P = 0.029), aPPT (P < 0.022), and INR (P < 0.033). This randomized controlled trial demonstrates that administration of HA does not affect the blood loss as compared to infusion of LR. Also the use of HA did not affect the need for blood transfusion, the incidence of postoperative complications, or the hospital in-stay. Yet, albumin decreases coagulation competence during major surgery and the blood loss is related to TEG-MA rather than to plasma coagulation variables. Wolters Kluwer Health 2016-03-07 /pmc/articles/PMC4782842/ /pubmed/26945358 http://dx.doi.org/10.1097/MD.0000000000002720 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0
spellingShingle 3300
Rasmussen, Kirsten C.
Højskov, Michael
Johansson, Pär I.
Kridina, Irina
Kistorp, Thomas
Salling, Lisbeth
Nielsen, Henning B.
Ruhnau, Birgitte
Pedersen, Tom
Secher, Niels H.
Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title_full Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title_fullStr Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title_full_unstemmed Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title_short Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial
title_sort impact of albumin on coagulation competence and hemorrhage during major surgery: a randomized controlled trial
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782842/
https://www.ncbi.nlm.nih.gov/pubmed/26945358
http://dx.doi.org/10.1097/MD.0000000000002720
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