Fibrinogen Concentrate Reverses Dilutional Coagulopathy Induced In Vitro by Saline but Not by Hydroxyethyl Starch 6%

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Abstract
Severe bleeding often induces coagulopathy via loss, consumption,anddilutionofclottingfactorsandplate- lets. The aims of our in vitro study were to characterize the influence of progressive hemodilution with either NaCl 0.9% or hydroxyethyl starch (HES) 6% on blood clot formation and to analyze the effect of substitution of fibrinogen and platelets on dilutional coagulopathy. Whole blood samples drawn from 8 volunteers were diluted from 20% to 80% of the sample volume with both diluents separately. Clot formation was measured by thrombelastography. At a 60% dilution, either fibrino- gen and/or platelets were added to the samples. Clot firmness became critical after 40% dilution with HES 6% but not until 60% dilution with NaCl 0.9%. When platelet functionwasblocked,fibrinpolymerizationwasseverely impaired after 20% dilution with HES 6%, whereas such aneffectwasonlyseenafter80%dilutionwithNaCl0.9%. The addition of fibrinogen reconstituted the clot firmness in the presence of NaCl 0.9%, but this had only a minor effect after dilution with HES 6%. Platelets alone or in ad- ditionwerenotabletoimproveclotfirmnesstoaclinically relevantextent.Dilutionalcoagulopathyinducedbycrys- talloids can, in vitro, be effectively reversed by supple-
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