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Hextend attenuates hypercoagulability after severe liver injury in swine.
J Trauma. 2005 Sep; 59(3):589-93; discussion 593-4.JT

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 animals 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.

Authors+Show Affiliations

Department of Surgery, The University of Texas Health Science Center at Houston, Texas 77030, USA. samual.todd@uth.tmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

16361900

Citation

Todd, S Rob, et al. "Hextend Attenuates Hypercoagulability After Severe Liver Injury in Swine." The Journal of Trauma, vol. 59, no. 3, 2005, pp. 589-93; discussion 593-4.
Todd SR, Malinoski D, Muller PJ, et al. Hextend attenuates hypercoagulability after severe liver injury in swine. J Trauma. 2005;59(3):589-93; discussion 593-4.
Todd, S. R., Malinoski, D., Muller, P. J., & Schreiber, M. A. (2005). Hextend attenuates hypercoagulability after severe liver injury in swine. The Journal of Trauma, 59(3), 589-93; discussion 593-4.
Todd SR, et al. Hextend Attenuates Hypercoagulability After Severe Liver Injury in Swine. J Trauma. 2005;59(3):589-93; discussion 593-4. PubMed PMID: 16361900.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hextend attenuates hypercoagulability after severe liver injury in swine. AU - Todd,S Rob, AU - Malinoski,Darren, AU - Muller,Patrick J, AU - Schreiber,Martin A, PY - 2005/12/20/pubmed PY - 2006/2/24/medline PY - 2005/12/20/entrez SP - 589-93; discussion 593-4 JF - The Journal of trauma JO - J Trauma VL - 59 IS - 3 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 animals 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. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/16361900/Hextend_attenuates_hypercoagulability_after_severe_liver_injury_in_swine_ L2 - https://Insights.ovid.com/pubmed?pmid=16361900 DB - PRIME DP - Unbound Medicine ER -