Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo
The study was conducted to explore the effects of colloid and crystalloid solutions on activation of fibrinolysis during orthopaedic surgery and to determine whether fluids facilitate clot dissolution at a particular fibrinolytic activity. Tissue-type plasminogen activator (t-PA) and plasminogen act...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2008-03, Vol.100 (3), p.307-314 |
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| creator | Mittermayr, M Streif, W Haas, T Fries, D Velik-Salchner, C Klingler, A Innerhofer, P |
| description | The study was conducted to explore the effects of colloid and crystalloid solutions on activation of fibrinolysis during orthopaedic surgery and to determine whether fluids facilitate clot dissolution at a particular fibrinolytic activity.
Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured in plasma samples of 66 orthopaedic patients randomly receiving gelatin solution, hydroxyethyl starch (HES) (130/0.4), or exclusively Ringer's lactate solution. Plasma obtained before induction of anaesthesia (undiluted) and at the end of surgery (diluted) was exposed to recombinant tissue plasminogen activator (r-tPA) in vitro and analysed by modified thrombelastography (ROTEM®).
There were similar changes in t-PA and PAI-1 concentrations in the gelatin, HES, and Ringer's lactate groups. When compared with the effect of r-tPA on undiluted plasma samples, the presence of colloids prompted faster clot dissolution than did Ringer's lactate solution. Lysis index at 30 min decreased significantly [median (min/max); P vs Ringer's lactate solution] to 43 (1/82)% (P=0.007), 14 (3/70)% (P |
| doi_str_mv | 10.1093/bja/aem363 |
| format | Article |
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Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured in plasma samples of 66 orthopaedic patients randomly receiving gelatin solution, hydroxyethyl starch (HES) (130/0.4), or exclusively Ringer's lactate solution. Plasma obtained before induction of anaesthesia (undiluted) and at the end of surgery (diluted) was exposed to recombinant tissue plasminogen activator (r-tPA) in vitro and analysed by modified thrombelastography (ROTEM®).
There were similar changes in t-PA and PAI-1 concentrations in the gelatin, HES, and Ringer's lactate groups. When compared with the effect of r-tPA on undiluted plasma samples, the presence of colloids prompted faster clot dissolution than did Ringer's lactate solution. Lysis index at 30 min decreased significantly [median (min/max); P vs Ringer's lactate solution] to 43 (1/82)% (P=0.007), 14 (3/70)% (P<0.001), and 91 (34/97)%, lysis onset time decreased to 1269 (1054/1743) s (P=0.007), 972 (490/1565) s (P<0.001), and 1970 (1260/2165) s, and lysis time to 2469 (1586/3303) s (P=0.019), 2002 (1569/3600) s (P=0.006), and 3012 (2017/3600) s in the gelatin, HES, and Ringer's lactate groups, respectively.
The type of i.v. fluid used does not influence endogenously occurring fibrinolytic activity in patients undergoing major orthopaedic surgery. However, during hyperfibrinolysis, the presence of HES or gelatin solution facilitates clot disintegration to a greater extent than Ringer's lactate solution, because the weaker clots formed with colloids dissolve faster.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/aem363</identifier><identifier>PMID: 18158312</identifier><identifier>CODEN: BJANAD</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Biomarkers - blood ; blood ; blood, coagulation ; blood, haemodilution ; coagulation ; Fibrin - metabolism ; Fibrinolysis - drug effects ; Gelatin - pharmacology ; haemodilution ; Humans ; Hydroxyethyl Starch Derivatives - pharmacology ; Intraoperative Care - methods ; Isotonic Solutions - pharmacology ; measurement techniques ; measurement techniques, thrombelastograph ; Medical sciences ; Middle Aged ; Orthopedic Procedures ; Plasma Substitutes - pharmacology ; Plasminogen Activator Inhibitor 1 - blood ; thrombelastograph ; Thrombelastography ; Tissue Plasminogen Activator - blood ; Tissue Plasminogen Activator - pharmacology</subject><ispartof>British journal of anaesthesia : BJA, 2008-03, Vol.100 (3), p.307-314</ispartof><rights>2008 British Journal of Anaesthesia</rights><rights>The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2008</rights><rights>2008 INIST-CNRS</rights><rights>Copyright Oxford Publishing Limited(England) Mar 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c491t-4ca78481c79f49ea9bbc063621452fdb4a24315109799d40a45417fcd6308f0b3</citedby><cites>FETCH-LOGICAL-c491t-4ca78481c79f49ea9bbc063621452fdb4a24315109799d40a45417fcd6308f0b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20110353$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18158312$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mittermayr, M</creatorcontrib><creatorcontrib>Streif, W</creatorcontrib><creatorcontrib>Haas, T</creatorcontrib><creatorcontrib>Fries, D</creatorcontrib><creatorcontrib>Velik-Salchner, C</creatorcontrib><creatorcontrib>Klingler, A</creatorcontrib><creatorcontrib>Innerhofer, P</creatorcontrib><title>Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>The study was conducted to explore the effects of colloid and crystalloid solutions on activation of fibrinolysis during orthopaedic surgery and to determine whether fluids facilitate clot dissolution at a particular fibrinolytic activity.
Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured in plasma samples of 66 orthopaedic patients randomly receiving gelatin solution, hydroxyethyl starch (HES) (130/0.4), or exclusively Ringer's lactate solution. Plasma obtained before induction of anaesthesia (undiluted) and at the end of surgery (diluted) was exposed to recombinant tissue plasminogen activator (r-tPA) in vitro and analysed by modified thrombelastography (ROTEM®).
There were similar changes in t-PA and PAI-1 concentrations in the gelatin, HES, and Ringer's lactate groups. When compared with the effect of r-tPA on undiluted plasma samples, the presence of colloids prompted faster clot dissolution than did Ringer's lactate solution. Lysis index at 30 min decreased significantly [median (min/max); P vs Ringer's lactate solution] to 43 (1/82)% (P=0.007), 14 (3/70)% (P<0.001), and 91 (34/97)%, lysis onset time decreased to 1269 (1054/1743) s (P=0.007), 972 (490/1565) s (P<0.001), and 1970 (1260/2165) s, and lysis time to 2469 (1586/3303) s (P=0.019), 2002 (1569/3600) s (P=0.006), and 3012 (2017/3600) s in the gelatin, HES, and Ringer's lactate groups, respectively.
The type of i.v. fluid used does not influence endogenously occurring fibrinolytic activity in patients undergoing major orthopaedic surgery. However, during hyperfibrinolysis, the presence of HES or gelatin solution facilitates clot disintegration to a greater extent than Ringer's lactate solution, because the weaker clots formed with colloids dissolve faster.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>blood</subject><subject>blood, coagulation</subject><subject>blood, haemodilution</subject><subject>coagulation</subject><subject>Fibrin - metabolism</subject><subject>Fibrinolysis - drug effects</subject><subject>Gelatin - pharmacology</subject><subject>haemodilution</subject><subject>Humans</subject><subject>Hydroxyethyl Starch Derivatives - pharmacology</subject><subject>Intraoperative Care - methods</subject><subject>Isotonic Solutions - pharmacology</subject><subject>measurement techniques</subject><subject>measurement techniques, thrombelastograph</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Orthopedic Procedures</subject><subject>Plasma Substitutes - pharmacology</subject><subject>Plasminogen Activator Inhibitor 1 - blood</subject><subject>thrombelastograph</subject><subject>Thrombelastography</subject><subject>Tissue Plasminogen Activator - blood</subject><subject>Tissue Plasminogen Activator - pharmacology</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kdFqFDEUhgdRbK3e-AASBL0QxuZMMpOZS6m1KxZEqCDehEySkawzyTbJLF2fywf0rLO2IOJVEs53_hPOVxRPgb4G2rHTfq1OlZ1Yw-4Vx8AFlI0QcL84ppSKknZQHRWPUlpTCqLq6ofFEbRQtwyq4-Ln-TBYnRMJA9FhHIMzRHlDdNylrJZ3CuOcXfAIeWK9Cd-sD3MiSme3VfvKvntwfXQ-jLvk0u-IaPGWldd2X95gZbLR_bDmgJIckNFh6p1XPpPsUpot2YwqTRiEQ_5MCJEoY7DR3pCt24bHxYNBjck-OZwnxed351dnq_Ly48X7szeXpeYd5JJrJVreghbdwDurur7XtGFNBbyuBtNzVXEGNe5QdJ3hVPGagxi0aRhtB9qzk-LlkruJ4Xq2KcvJJW3HUXmLC5CCMsqhrRB8_he4DnP0-DcJGM5YWwFCrxZIx5BStIPcRDepuJNA5V6kRJFyEYnws0Pi3E_W3KEHcwi8OAAqaTUOERft0i1XUQDKanbHhXnz_4HlwqEze3NLqvhdNoKJWq6-fJXt6tNbuGiv5Afk-cJbFLB1NsqknUXZxqHULE1w_xrzC7DP2OA</recordid><startdate>20080301</startdate><enddate>20080301</enddate><creator>Mittermayr, M</creator><creator>Streif, W</creator><creator>Haas, T</creator><creator>Fries, D</creator><creator>Velik-Salchner, C</creator><creator>Klingler, A</creator><creator>Innerhofer, P</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>6I.</scope><scope>AAFTH</scope><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20080301</creationdate><title>Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo</title><author>Mittermayr, M ; Streif, W ; Haas, T ; Fries, D ; Velik-Salchner, C ; Klingler, A ; Innerhofer, P</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c491t-4ca78481c79f49ea9bbc063621452fdb4a24315109799d40a45417fcd6308f0b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>blood</topic><topic>blood, coagulation</topic><topic>blood, haemodilution</topic><topic>coagulation</topic><topic>Fibrin - metabolism</topic><topic>Fibrinolysis - drug effects</topic><topic>Gelatin - pharmacology</topic><topic>haemodilution</topic><topic>Humans</topic><topic>Hydroxyethyl Starch Derivatives - pharmacology</topic><topic>Intraoperative Care - methods</topic><topic>Isotonic Solutions - pharmacology</topic><topic>measurement techniques</topic><topic>measurement techniques, thrombelastograph</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Orthopedic Procedures</topic><topic>Plasma Substitutes - pharmacology</topic><topic>Plasminogen Activator Inhibitor 1 - blood</topic><topic>thrombelastograph</topic><topic>Thrombelastography</topic><topic>Tissue Plasminogen Activator - blood</topic><topic>Tissue Plasminogen Activator - pharmacology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mittermayr, M</creatorcontrib><creatorcontrib>Streif, W</creatorcontrib><creatorcontrib>Haas, T</creatorcontrib><creatorcontrib>Fries, D</creatorcontrib><creatorcontrib>Velik-Salchner, C</creatorcontrib><creatorcontrib>Klingler, A</creatorcontrib><creatorcontrib>Innerhofer, P</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mittermayr, M</au><au>Streif, W</au><au>Haas, T</au><au>Fries, D</au><au>Velik-Salchner, C</au><au>Klingler, A</au><au>Innerhofer, P</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2008-03-01</date><risdate>2008</risdate><volume>100</volume><issue>3</issue><spage>307</spage><epage>314</epage><pages>307-314</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><coden>BJANAD</coden><abstract>The study was conducted to explore the effects of colloid and crystalloid solutions on activation of fibrinolysis during orthopaedic surgery and to determine whether fluids facilitate clot dissolution at a particular fibrinolytic activity.
Tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1) were measured in plasma samples of 66 orthopaedic patients randomly receiving gelatin solution, hydroxyethyl starch (HES) (130/0.4), or exclusively Ringer's lactate solution. Plasma obtained before induction of anaesthesia (undiluted) and at the end of surgery (diluted) was exposed to recombinant tissue plasminogen activator (r-tPA) in vitro and analysed by modified thrombelastography (ROTEM®).
There were similar changes in t-PA and PAI-1 concentrations in the gelatin, HES, and Ringer's lactate groups. When compared with the effect of r-tPA on undiluted plasma samples, the presence of colloids prompted faster clot dissolution than did Ringer's lactate solution. Lysis index at 30 min decreased significantly [median (min/max); P vs Ringer's lactate solution] to 43 (1/82)% (P=0.007), 14 (3/70)% (P<0.001), and 91 (34/97)%, lysis onset time decreased to 1269 (1054/1743) s (P=0.007), 972 (490/1565) s (P<0.001), and 1970 (1260/2165) s, and lysis time to 2469 (1586/3303) s (P=0.019), 2002 (1569/3600) s (P=0.006), and 3012 (2017/3600) s in the gelatin, HES, and Ringer's lactate groups, respectively.
The type of i.v. fluid used does not influence endogenously occurring fibrinolytic activity in patients undergoing major orthopaedic surgery. However, during hyperfibrinolysis, the presence of HES or gelatin solution facilitates clot disintegration to a greater extent than Ringer's lactate solution, because the weaker clots formed with colloids dissolve faster.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>18158312</pmid><doi>10.1093/bja/aem363</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Biomarkers - blood blood blood, coagulation blood, haemodilution coagulation Fibrin - metabolism Fibrinolysis - drug effects Gelatin - pharmacology haemodilution Humans Hydroxyethyl Starch Derivatives - pharmacology Intraoperative Care - methods Isotonic Solutions - pharmacology measurement techniques measurement techniques, thrombelastograph Medical sciences Middle Aged Orthopedic Procedures Plasma Substitutes - pharmacology Plasminogen Activator Inhibitor 1 - blood thrombelastograph Thrombelastography Tissue Plasminogen Activator - blood Tissue Plasminogen Activator - pharmacology |
| title | Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo |
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