Objective:
Mannitol 20% and succinylated gelatin 4% are routinely used in neurosurgical procedures. The aim of this in vitro study was to explore the influence of both agents on blood coagulation and platelet function.
Methods:
Blood from 21 healthy volunteers was obtained and then diluted so as to form five groups: (1) 7% dilution with mannitol; (2) 10% dilution with gelatin; (3) 17% dilution with isotonic balanced electrolyte solution; (4) 17% dilution with mannitol+gelatin; and (5) undiluted blood. The extrinsic thrombelastometry (EXTEM) and fibrin thrombelastometry (FIBTEM) tests were examined by rotational thrombelastometry via ROTEM®, and thrombocyte aggregometry with the aspirin inhibiting- (ASPI), adenosine diphosphate- (ADP), and thrombin-activating protein (TRAP) tests performed by Multiplate.
Results:
In the EXTEM test clot formation time, the alpha angle, and maximum clot firmness were significantly reduced by mannitol and the combination of mannitol with gelatin. The platelet function tested in the ADP test was also significantly reduced with this combination.
Conclusion:
In this in vitro study, clinically relevant dilutions of mannitol and gelatin showed a significant inhibition of whole blood coagulation and the platelet function, which could be detrimental in neurosurgical settings.
Keywords: Coagulation, gelatin, mannitol, platelet aggregometry, platelet function, thrombelastometry