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This prospective randomized single blinded study nicely showed the dual effects of plasma substitutes used in acute normovolemic hemodilution. Solutions that have an impact on hemostasis like dextran and high molecular weight starches may attenuate the hypercoagulability phase usually observed in the immediate postoperative period, but their use can be associated with increased perioperative bleeding. Solutions without significant effect on hemostasis like crystalloids and albumin will not prevent the development of a postoperative hypercoagulability phase but will have less impact on perioperative blood losses.

– Philippe Van der Linden