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. 2017 Apr;45(2):87-92.
doi: 10.5152/TJAR.2017.74875. Epub 2017 Apr 1.

A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

Achmet Ali  1 , Bilge Şencan  1 , Pulat Akın Sabancı  2 , Demet Altun  1 , Aylin Tetik  1 , Lerzan Recep Doğan  1 , İbrahim Özkan Akıncı  1
Affiliations

A Comparison of the Effects of 20% Mannitol and 3% NaCl on Coagulation Parameters In Vitro using ROTEM: A Prospective Randomized Crossover Study

Achmet Ali et al. Turk J Anaesthesiol Reanim. 2017 Apr.

Abstract

Objective: The aim of the present study is to compare the effect of 20% mannitol and 3% NaCl on blood coagulation in vitro using rotational thromboelastometry (ROTEM).

Methods: Twenty-millilitre blood samples were obtained from 15 volunteers. In each group, 2 mL blood samples were collected into both polypropylene tubes and EDTA tubes for ROTEM and hemogram analysis. After sampling, blood samples were diluted with test solutions. Group C (control): Only blood, Group M (mannitol): 7% vol 20% mannitol concentration in the blood, Group hypertonic saline (HS): 7% vol 3% hypertonic saline (NaCl) in the blood, Group M/H (mannitol and hydroxyethyl starch solutions [HES]): 6% vol 20% mannitol concentration and 8% vol HES in the blood and Group HS/H (hypertonic saline and HES): 6% vol 3% hypertonic saline concentration and 8% vol HES in the blood. The following thromboelastometric parameters were measured automatically: clotting time (CT) and clot formation time (CFT) with intrinsic activation by tissue factor (InTEM), CT, CFT and maximum clot firmness (MCF) with extrinsic activation by tissue factor (ExTEM) and MCF with FibTEM.

Results: The ExTEM CT value was found to be significantly longer in the M/H group than in the controls. The ExTEM CFT median and percentile values were: group C: 85 s (70-95 s), group M: 115 s (94-128 s), group HS: 102 s (84-114 s), group M/H: 128 s (110-144 s) and group HS/H: 118 s (107-132 s). In all the groups, FibTEM MCF values were significantly lower than the control and also there was a significant difference between groups M and HS according to FibTEM MCF values.

Conclusion: Whole-blood coagulation disorder induced by these solutions is mainly dependent on fibrinogen and fibrin interaction. However, 3% HS has much less negative effect on coagulation.

Keywords: 20% mannitol; 3% NaCl; coagulation; neuroanaesthesia.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Flow chart of the study
Figure 2
Figure 2
Composition of dilutions
Figure 3
Figure 3
a, b. CT (a) and CFT (b) values in ExTEM. A, Values were normally distributed. ANOVA test and Tukey test were used for comparison. *: p<0.05 compared with the control group. b, Values were not normally distributed. The Kruskal–Wallis test was used for comparison. *: p<0.05 compared with the control group. ¶p<0.001 compared with the control group. ¥p<0.05 compared with group HS
Figure 4
Figure 4
ExTEM and FibTEM MCF values. Values were normally distributed. ANOVA and Tukey test used for comparison. *: p<0.05 compared with the control group. ¶: p<0.001 compared with the control group. ¥: p<0.05 compared with the group HS. β: p<0.001 compared with groups M and HS
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References

    1. Luostarinen T, Niiya T, Schramko A, Rosenberg P, Niemi T. Comparison of hypertonic saline and mannitol on whole blood coagulation in vitro assessed by thromboelastometry. Neurocrit Care. 2011;14:238–43. https://doi.org/10.1007/s12028-010-9475-6. - DOI - PubMed
    1. The Brain Trauma Foundation. The American Association of Neurological Surgeons. The Joint Section on Neurotrauma and Critical Care. Initial management. J Neurotrauma. 2000;17:463–9. - PubMed
    1. Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke. 1998;29:1550–5. https://doi.org/10.1161/01.STR.29.8.1550. - DOI - PubMed
    1. Harutjunyan L, Holz C, Rieger A, Menzel M, Grond S, Soukup J. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patients: A randomized clinical trial. Crit Care. 2005;9:530–40. https://doi.org/10.1186/cc3767. - DOI - PMC - PubMed
    1. Rozet I, Tontisirin N, Muangman S, Vavilala MS, Souter MJ, Lee LA, et al. Effect of equiosmolar solutions of mannitol versus hypertonic saline on intraoperative brain relaxation and electrolyte balance. Anesthesiology. 2007;107:697–704. https://doi.org/10.1097/01.anes.0000286980.92759.94. - DOI - PubMed

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