Abstract
Purpose
Colloid solutions are widely used to prevent or to correct hypovolemia in surgical patients. Although more efficacious than crystalloids, they are more expensive and can be associated with adverse effects, in particular when they interfere with the hemostatic system.
Methods
This narrative review focuses on the effects of albumin and synthetic colloids on the biological markers of coagulation and their clinical consequences.
Results
All colloidal plasma substitutes interfere with the physiological mechanisms of hemostasis either through a non-specific effect correlated to the degree of hemodilution or through specific actions of these macromolecules on platelet function, coagulation proteins, and the fibrinolytic system. Albumin has the least effect, while high molecular weight (Mw) dextrans and hydroxyethyl starches (HES) have the most significant effects. Gelatins and medium Mw HES with a low molar substitution ratio have moderate and, probably, comparable effects. The use of dextrans and highin vivo Mw HES may be associated with increased bleeding, while gelatins and low iin vivo Mw HES are unlikely to have such an effect.
Conclusions
In most cases, the clinical consequences of the biological effects of colloids on hemostasis are limited, provided that safety considerations are observed (maximum daily dosage, duration of treatment, patient’s hemostatic status, clinical conditions). The implications may be different in patients with hemostatic disorders, either inherited or related to preoperative antiplatelet or anticoagulant treatment. In these patients, crystalloids, gelatins or even albumin solutions should be preferred when hemodilution exceeds 30% of the circulating blood volume.
Résumé
Objectif
Les solutions colloïdes sont très utilisées pour prévenir ou corriger ľhypovolémie chez les patients de chirurgie. Bien que plus efficaces que les cristalloïdes, elles sont plus chères et peuvent avoir des effets indésirables, en particulier quand elles perturbent le système hémostatique.
Méthode
La présente revue descriptive se concentre sur les effets de ľalbumine et des colloïdes synthétiques sur les marqueurs biologiques de la coagulation et leurs conséquences cliniques.
Résultats
Tous les substituts colloïdaux plasmatiques nuisent aux mécanismes physiologiques de ľhémostase, par un effet non spécifique corrélé au degré ďhémodilution ou par des actions spécifiques de ces macromolécules sur la fonction plaquettaire, les protéines de la coagulation et le système fibrinolytique. Ľalbumine a le moins ďeffet, alors que les dextranes et amidons hydroxyéthylés (AHE) de haut poids moléculaire (PM) ont les plus importants effets. La gélatine et ľAHE de PM moyen qui présentent un ratio de substitution molaire faible ont des effets modérés et, probablement, comparables. Ľusage de dextranes et ďAHE de haut PM in vivo peut être associé à un saignement accru, tandis que les gélatines et les AHE de faible PM in vivo n’ont pas cet effet.
Conclusion
En général, les conséquences cliniques des effets biologiques des colloïdes sur ľhémostase sont limités, pourvu que les règles de sécurité soient observées (dosage quotidien maximal, durée du traitement, état hémostatique du patient, conditions cliniques). Les effets peuvent être différents chez les patients qui ont des troubles hémostatiques héréditaires ou reliés à un traitement préopératoire antiplaquettaire ou anticoagulant. Dans ce cas, les solutions de cristalloïde, de gélatine ou même ďalbumine devraient être préférées quand ľhémodilution dépasse 30 % du volume du sang circulant.
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Linden, P.V.d., Ickx, B.E. The effects of colloid solutions on hemostasis. Can J Anesth 53 (Suppl 2), S30–S39 (2006). https://doi.org/10.1007/BF03022250
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DOI: https://doi.org/10.1007/BF03022250