Fluid-induced coagulopathy does the type of fluid make a difference.docVIP

Marx and Schuerholz Critical Care 2010,14:118 /content/14/1/118 COMMENTARY Fluid-induced coagulopathy: does the type of ? uid make a di? erence? Gernot Marx* and Tobias Schuerholz See related research of Sossdorf et al., /content/13/6/R208 the contribution of ? brinogen to the clot ? rmness) with a Abstract 10% hemodilution by both tested HES solutions Crystalloid and colloid solutions are used for resuscitation of the critically ill. One set of options, widely used today, are di?erent preparations of hydroxyethyl starch (HES). However, the safety of HES regarding impairment of blood coagulation remains incompletely elucidated, a circumstance that limits its clinical use. Understanding mechanisms and potential di?erences between low-molecular and compared with saline. Other parameters of ROTEM? were a? ected by HES 200/0.5 but not by HES 130/0.4. A higher hemodilution of 40% showed comparable results for the two HESs. Accordingly, Innerhofer and colleagues [3] could demonstrate an inhibition of primary hemo- stasis by HES 200/0.5 and gelatine. Sossdorf and colleagues further demonstrated that a clinical reasonable hemodilution of 10% does not a? ect low-substituted HES and other HES solutions seems clinically relevant. the tested platelet receptors with both HESs when compared with saline after activation with adenosine-di- phosphate (ADP) or thrombin receptor agonist peptide (TRAP). Without the addition of an agonist, the authors Since recog nizing platelets as an important part in detected a signi? cant 3% to 5% di? erence of platelet- coagulation some 125 years ago, the scienti? c community neutrophil conjugates after 10% hemodilution with 6% has evaluated platelets as a key player between HES 130/0.4. In contrast, 10% HES 200/0.5 may adhere to in? ammation and coagulation. Critically ill patients the platelet surface