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Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function In Vitro.

Abstract

Objective

Mannitol 20% and succinylated gelatin 4% are routinely used in neurosurgical procedures. The aim of this in vitro study was to explore the influence of both agents on blood coagulation and platelet function.

Methods

Blood from 21 healthy volunteers was obtained and then diluted so as to form five groups: (1) 7% dilution with mannitol; (2) 10% dilution with gelatin; (3) 17% dilution with isotonic balanced electrolyte solution; (4) 17% dilution with mannitol+gelatin; and (5) undiluted blood. The extrinsic thrombelastometry (EXTEM) and fibrin thrombelastometry (FIBTEM) tests were examined by rotational thrombelastometry via ROTEM®, and thrombocyte aggregometry with the aspirin inhibiting- (ASPI), adenosine diphosphate- (ADP), and thrombin-activating protein (TRAP) tests performed by Multiplate.

Results

In the EXTEM test clot formation time, the alpha angle, and maximum clot firmness were significantly reduced by mannitol and the combination of mannitol with gelatin. The platelet function tested in the ADP test was also significantly reduced with this combination.

Conclusion

In this in vitro study, clinically relevant dilutions of mannitol and gelatin showed a significant inhibition of whole blood coagulation and the platelet function, which could be detrimental in neurosurgical settings.

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  • Authors+Show Affiliations

    ,

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    ,

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    ,

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    ,

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    ,

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    Department of Anaesthesiology and Intensive Care, Medical School Hannover, Hannover, Germany.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31183466

    Citation

    Palmaers, Thomas, et al. "Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function in Vitro." Turkish Journal of Anaesthesiology and Reanimation, vol. 47, no. 3, 2019, pp. 199-205.
    Palmaers T, Krämer E, Hinsenkamp J, et al. Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function In Vitro. Turk J Anaesthesiol Reanim. 2019;47(3):199-205.
    Palmaers, T., Krämer, E., Hinsenkamp, J., Eismann, H., Scheinichen, D., & Frank, P. (2019). Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function In Vitro. Turkish Journal of Anaesthesiology and Reanimation, 47(3), pp. 199-205. doi:10.5152/TJAR.2019.86300.
    Palmaers T, et al. Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function in Vitro. Turk J Anaesthesiol Reanim. 2019;47(3):199-205. PubMed PMID: 31183466.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Mannitol and the Combination of Mannitol and Gelatin Impair Whole Blood Coagulation and the Platelet Function In Vitro. AU - Palmaers,Thomas, AU - Krämer,Elke, AU - Hinsenkamp,Julia, AU - Eismann,Hendrik, AU - Scheinichen,Dirk, AU - Frank,Paul, Y1 - 2019/02/19/ PY - 2018/08/08/received PY - 2018/11/05/accepted PY - 2019/6/12/entrez PY - 2019/6/12/pubmed PY - 2019/6/12/medline KW - Coagulation KW - gelatin KW - mannitol KW - platelet aggregometry KW - platelet function KW - thrombelastometry SP - 199 EP - 205 JF - Turkish journal of anaesthesiology and reanimation JO - Turk J Anaesthesiol Reanim VL - 47 IS - 3 N2 - Objective: Mannitol 20% and succinylated gelatin 4% are routinely used in neurosurgical procedures. The aim of this in vitro study was to explore the influence of both agents on blood coagulation and platelet function. Methods: Blood from 21 healthy volunteers was obtained and then diluted so as to form five groups: (1) 7% dilution with mannitol; (2) 10% dilution with gelatin; (3) 17% dilution with isotonic balanced electrolyte solution; (4) 17% dilution with mannitol+gelatin; and (5) undiluted blood. The extrinsic thrombelastometry (EXTEM) and fibrin thrombelastometry (FIBTEM) tests were examined by rotational thrombelastometry via ROTEM®, and thrombocyte aggregometry with the aspirin inhibiting- (ASPI), adenosine diphosphate- (ADP), and thrombin-activating protein (TRAP) tests performed by Multiplate. Results: In the EXTEM test clot formation time, the alpha angle, and maximum clot firmness were significantly reduced by mannitol and the combination of mannitol with gelatin. The platelet function tested in the ADP test was also significantly reduced with this combination. Conclusion: In this in vitro study, clinically relevant dilutions of mannitol and gelatin showed a significant inhibition of whole blood coagulation and the platelet function, which could be detrimental in neurosurgical settings. SN - 2667-677X UR - https://www.unboundmedicine.com/medline/citation/31183466/Mannitol_and_the_Combination_of_Mannitol_and_Gelatin_Impair_Whole_Blood_Coagulation_and_the_Platelet_Function_In_Vitro L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31183466/ DB - PRIME DP - Unbound Medicine ER -