Assessment of hemostatic changes after crystalloid and colloid fluid preloading in trauma patients using standard coagulation parameters and thromboelastography

摘要: The choice of an ideal fluid administered post trauma and its subsequent influence on coagulation still poses a clinical dilemma. Hence, this study was designed to assess the influence of in vivo hemodilution with various fluid preparations [4% gelatin, 6% hydoxyethyl starch [HES], Ringer's lactate, 0.9% normal saline] on coagulation using standard coagulation parameters and real-time thromboelastography [TEG] in patients undergoing elective surgery post trauma. In a randomized, double-blind study, 100 patients of either sex and age, belonging to ASA Grades I and II, scheduled for elective surgeries were allocated into four groups of 25 each according to the type of fluid infused. Group G [4% gelatin], Group N [0.9% normal saline], Group R [Ringer's lactate], and Group H [6% HES] received preloading with 1 L of fluid according to the group. The coagulation status of the patients was assessed during perioperative period [before surgery, after fluid preloading, and at the end of the surgery] using both conventional coagulation analysis and TEG. Analysis of variance [ANOVA], post hoc and Pearson Chi-square test were used. In all the patients preloaded with gelatin, there was a significant increase in prothrombin time index [PTI; 14.88+/-0.90 vs. 13.78+/-3.01, P< 0.001] and international normalized ratio [INR; 1.12+/-0.09 vs. 1.09+/-0.19, P< 0.05] compared to the baseline value. An increase was observed in these parameters in the postoperative period also. In the HES group, there was statistically significant increase in PT time [15.70+/-1.51 vs. 13.74+/-0.75, P= 0.01] and INR [1.20+/-0.15 vs. 1.03+/-0.17, P< 0.001] as compared to the baseline. In …