Impaired hemostasis frequently occurs after
traumatic shock and
resuscitation. The prehospital fluid administered can exacerbate subsequent
bleeding and coagulopathy.
Hypertonic solutions are recommended as first-line treatment of
traumatic shock; however, their effects on coagulation are unclear. This study explores the impact of
resuscitation with various
hypertonic solutions on early coagulopathy after
trauma. We conducted a prospective observational subgroup analysis of large clinical trial on out-of-hospital single-bolus (250 mL) hypertonic fluid
resuscitation of
hemorrhagic shock trauma patients (systolic blood pressure, ≤70 mmHg). Patients received 7.5% NaCl (HS), 7.5% NaCl/6%
Dextran 70 (HSD), or
0.9% NaCl (
normal saline [NS]) in the prehospital setting. Thirty-four patients were included: 9 HS, 8 HSD, 17 NS. Treatment with HS/HSD led to higher admission systolic blood pressure,
sodium, chloride, and osmolarity, whereas
lactate, base deficit, fluid requirement, and
hemoglobin levels were similar in all groups. The HSD-resuscitated patients had higher admission international normalized ratio values and more hypocoagulable patients, 62% (vs. 55% HS, 47% NS; P < 0.05). Prothrombotic
tissue factor was elevated in
shock treated with NS but depressed in both HS and HSD groups. Fibrinolytic
tissue plasminogen activator and anti-fibrinolytic
plasminogen activator inhibitor type 1 were increased by
shock but not
thrombin-activatable fibrinolysis inhibitor. The HSD patients had the worst imbalance between procoagulation/anticoagulation and profibrinolysis/antifibrinolysis, resulting in more hypocoagulability and hyperfibrinolysis. We concluded that
resuscitation with
hypertonic solutions, particularly HSD, worsens hypocoagulability and hyperfibrinolysis after
hemorrhagic shock in
trauma through imbalances in both procoagulants and
anticoagulants and both profibrinolytic and
antifibrinolytic activities.