British Journal of Anaesthesia, 2002, Vol. 89, No. 2 226-230
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Effects on coagulation of intravenous crystalloid or colloid in patients undergoing peripheral vascular surgery
1 Department of Anaesthesia and 2 Department of Haematology, University of Cape Town, Medical School, Observatory, Cape 7925, South Africa*Corresponding author
Declaration of interest: Fresenius AG contributed to the costs of the investigation.
Background. This study investigated whether haemodilution-enhanced coagulation can be demonstrated under regional anaesthesia, whether this occurs before surgery, and whether the fluid used influences the effect.
Methods. Patients were randomly allocated to receive either crystalloid or colloid intravenous fluid. An epidural was administered. Samples of venous blood were taken before fluid administration, after completion of the epidural and initial fluid load, during surgery before heparin, and after 24 h. Thrombelastograph® analysis was performed, and full blood count, international normalised ratio, activated partial thromboplastin time, D-dimers and thrombin–antithrombin complex were measured.
Results. In the crystalloid group, enhanced coagulation compared with baseline was demonstrated after initial fluid load (mean (SD) r-time 10.1 (4.9) min; P<0.033; k-time 3.5 (1.7) min; P<0.01; 
-angle 54.9 (13.9) degrees; P<0.01) and before heparin administration (r-time 8.8 (3.9) min; P<0.01; -angle 54.9 (12.6) degrees; P<0.02). There was no enhancement of coagulation in the colloid group. There were no changes from baseline after 24 h.
Conclusions. This study confirms that the enhanced perioperative coagulation mechanism is related to dilution, rather than surgery, and is triggered by rapid crystalloid haemodilution. Consideration should be given to the use of colloid rather than crystalloid solutions for rapid fluid loading in vasculopathic patients undergoing surgery.
Br J Anaesth 2002; 89: 226–30
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