An in vitro comparison of the effects of voluven (6% hydroxyethyl starch 130/0.4) and hespan (6% hydroxyethyl starch 670/0.75) on measures of blood coagulation in canine blood

Griego-Valles, Michelle; Buriko, Yekaterina; Prittie, Jennifer; Fox, Philip R.

doi:10.1111/vec.12541

Cited by 8 publications

(14 citation statements)

References 33 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In two in vitro studies, when whole blood samples were diluted with HES 130/0.4 (1:22, 1:9, 1:4), a hypocoagulable ROTEM tracing was found only at the highest dilution (1:4, mimicking in vivo administration of 30 ml/kg) [ 11 , 14 ]. Whereas, an impairment of secondary hemostasis has been identified after 1:5.5 dilution (comparable to a fluid dose of 20 ml/Kg) using ROTEG analysis [ 12 ]. The results of in vitro studies cannot be directly extrapolated to predict in vivo results, as the effect that a HES solution may have on hemostasis is largely determined by its in vivo pharmacokinetics [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs

et al. 2018

View full text Add to dashboard Cite

Background: The primary aim was to evaluate by means of thromboelastometry (ROTEM) the effects of hydroxyethyl starch (HES) 130/0.4 administered as a constant rate infusion (CRI) on hemostasis in hypoalbuminemic dogs. The second aim was to use ROTEM analysis to detect whether all hypoalbuminemic dogs of our population were hypercoagulable. Results: The study sample was 20 hypoalbuminemic dogs (albumin < 2 g/dl) with normal perfusion parameters and requiring intravenous fluid therapy. In order to support plasma colloid osmotic pressure, in addition to crystalloid, HES 130/0.4 was administered as a constant rate infusion at 1 ml/kg/h (group 1, n = 11) or 2 ml/kg/h for 24 h (group 2, n = 9). Blood samples were collected at baseline (T0) and 24 h postinfusion (T1); coagulation was assessed by standard coagulation profile (prothrombin time, activated partial thromboplastin time, and fibrinogen), and ROTEM analysis (in-TEM®, ex-TEM® and fib-TEM® profile). No statistically significant differences in ROTEM values in group 1 were observed (P > 0.05), whereas in group 2 statistically significant differences (P < 0.05) were found at T1 in the in-TEM® profile [decrease in clot formation time (P = 0.04) and increase in α angle (P = 0.02)] and in the ex-TEM® profile [increase in maximum clot firmness (P = 0.008) and α angle (P = 0.01)]; no changes were identified in the fib-TEM® profile. In both groups, a statistically significant decrease (P = 0.007) in hematocrit was noted, whereas no statistically significant differences in platelet count and standard coagulation profile were found. In group 2, a statistically significant increase in TS values (P = 0.03) was noted at T1. ROTEM tracings indicating a hypercoagulable state were observed in 7/20 dogs at T0 (5/11 in group 1 and 2/9 in the group 2). Conclusion: Our findings suggest that HES 130/0.4 administered as CRI does not cause hypocoagulability in hypoalbuminemic dogs. A trend toward hypercoagulability, probably related to the underlying diseases, was observed in group 2 at T1. Although all dogs were hyoalbuminemic, only 7/20 were hypercoagulable at T0, confirming the lack of correlation between albumin level and prothrombotic state.

show abstract

Section: Discussionmentioning

confidence: 99%

Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Common to these studies are measurements of platelet function and viscoelastic tests of coagulation. In vitro dilution of canine blood with high MW HES consistently causes hypocoagulability beyond dilution, as measured by TEG (97,98) and ROTEM (27). Two of those studies also assessed platelet function and did not show any effect beyond dilution on PCT (27,98).…”

Section: Hydroxyethyl Starchmentioning

confidence: 98%

“…Other studies measuring PCT have failed to detect an effect beyond dilution with low MW HES (27,29,98). Hypocoagulability beyond dilutional effects has also been demonstrated for low MW HES using TEG or ROTEM in three canine studies (27,37,98), but was not detected in a fourth (51). The only in vitro study of HES dilution of equine blood showed that both high and low MW HES caused significant platelet dysfunction and hypocoagulability, as measured by PCT, TEG, Sonoclot, optical platelet aggregometry, and activities of vWF and FVIII, with many changes in excess of the crystalloid controls (70).…”

Section: Hydroxyethyl Starchmentioning

confidence: 99%

“…Platelet dysfunction has been demonstrated by changes in PCT (28) or a flow chamber model (99). Other studies measuring PCT have failed to detect an effect beyond dilution with low MW HES (27,29,98). Hypocoagulability beyond dilutional effects has also been demonstrated for low MW HES using TEG or ROTEM in three canine studies (27,37,98), but was not detected in a fourth (51).…”

Section: Hydroxyethyl Starchmentioning

confidence: 99%

“…In vitro dilution of canine blood with high MW HES consistently causes hypocoagulability beyond dilution, as measured by TEG (97,98) and ROTEM (27). Two of those studies also assessed platelet function and did not show any effect beyond dilution on PCT (27,98). However, in another canine study, dilution with high MW HES showed significant prolongation of PCT, compared to 0.9% saline dilution (30).…”

Section: Hydroxyethyl Starchmentioning

confidence: 99%

See 2 more Smart Citations

Intravenous Fluid Administration and the Coagulation System

2021

View full text Add to dashboard Cite

Intravenous fluid administration in veterinary patients can alter coagulation function by several mechanisms. Both crystalloid and colloid fluids cause hemodilution, reducing platelet count and plasma coagulation protein concentrations. Hemodilution is associated with a hypercoagulable effect at low dilutions and a hypocoagulable effect at higher dilutions. Composition of crystalloid fluids likely has a minor effect, primarily dependent on fluid ion composition. Hypertonic crystalloids may also cause hypocoagulability. Colloids, both synthetic and natural, can cause hypocoagulability by several mechanisms beyond the effects of hemodilution. These include impaired platelet function, decreased plasma coagulation factor activity, impaired fibrin formation and crosslinking, and accelerated fibrinolysis. The vast majority of the veterinary literature investigates the hypocoagulable effects of hydroxyethyl starch–containing fluids using in vitro, experimental, and clinical studies. However, results are inconsistent, likely due to the varying doses and physicochemical properties of the specific fluid products across studies. In addition, some evidence exists for hypocoagulable effects of gelatin and albumin solutions. There is also evidence that these colloids increase the risk of clinical bleeding in people. Limitations of the veterinary evidence for the hypocoagulable effects of colloid fluids include a predominance of in vitro studies and in vivo studies using healthy subjects, which exclude the interaction of the effects of illness. Therefore, clinical relevance of these effects, especially for low-molecular-weight hydroxyethyl starch, is unknown. Firm recommendations about the most appropriate fluid to use in clinical scenarios cannot be made, although it is prudent to limit the dose of synthetic colloid in at-risk patients. Clinicians should closely monitor relevant coagulation assays and for evidence of hemorrhage in at-risk patients receiving any type of fluid therapy, especially in large volumes.

show abstract

In vitro effects of lactated Ringer's solution, hypertonic saline, hydroxyethyl starch, hypertonic saline/hydroxyethyl starch, and mannitol on thromboelastographic variables of canine whole blood

Chan

Hughes

Tennent‐Brown

et al. 2020

J Vet Emergen Crit Care

View full text Add to dashboard Cite

show abstract

An in vitro comparison of the effects of voluven (6% hydroxyethyl starch 130/0.4) and hespan (6% hydroxyethyl starch 670/0.75) on measures of blood coagulation in canine blood

Cited by 8 publications

References 33 publications

Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs

Thromboelastometric assessment of hemostasis following hydroxyethyl starch (130/0.4) administration as a constant rate infusion in hypoalbuminemic dogs

Intravenous Fluid Administration and the Coagulation System

In vitro effects of lactated Ringer's solution, hypertonic saline, hydroxyethyl starch, hypertonic saline/hydroxyethyl starch, and mannitol on thromboelastographic variables of canine whole blood

Contact Info

Product

Resources

About