The effects of intravenous fluids on thromboelastrographic variables in dogs

Abstract

Intravenous fluid resuscitation plays a fundamental role in treating dogs in haemorrhagic shock, as it can rapidly replenish lost intravascular volume and improve tissue perfusion. However, a consequence of intravenous fluid therapy is interference with haemostasis, which has a detrimental effect to trauma patients that are already haemostatically compromised. In people, intravenous fluid therapy can effect haemostasis and subsequently can increase haemorrhage, transfusion needs and mortality. The effects of intravenous fluids on haemostasis in dogs have not been widely established.

More recently, viscoelastic devices like thromboelastography have been used to examine haemostasis. Compared to conventional coagulation testing, viscoelastic devices have the advantages to be able to assess the speed and kinetics of clot formation, clot strength and even the breakdown of the clot. The aim of our study was to determine the effects of intravenous fluids on coagulation in dogs with the use of thromboelastography. The objective of our study was to determine the effect of dilution of canine whole blood with clinically relevant doses of common intravenous fluids on thrombelastographic variables. Our hypothesis was that in vitro dilution of canine whole blood from healthy dogs with intravenous fluids will induce dose-dependent changes in thromboelastographic variables consistent with hypocoagulability. Further, we hypothesized that the characteristics of the fluids, such as its ionic strength and osmolality, will effect thromboelastographic variables in addition to those of dilution alone.

The results of our study showed that in vitro dilution of canine whole blood with commonly used intravenous fluids lead to thromboelastographic changes consistent with hypocoagulability in a dose dependent manner. Besides dilution percentage, viscoelastic changes were influenced by fluid characteristics, specifically ionic strength, osmolality and colloidal properties. In our study, 7% hypertonic saline had the most severe effects on coagulation, followed by 20% Mannitol then 3.4% hypertonic saline. Hydroxyethyl starch 130/0.4 had minimal effects on coagulation besides a dilutional effect. The differential effect of fluid characteristics should be taken into consideration when resuscitating dogs with large fluid volumes, but clinical studies are still required to further delineate the importance of different resuscitation fluids and volumes on haemostasis in dogs.