Effect of Hydroxyethyl Starch and Dextran on Plasma Volume and Blood Hemostasis and Coagulation

Korttila, K; Gröhn, Pentti; Gordin, A.; Sundberg, Stig; Salo, Harri M.; Nissinen, Erkki; Mattila, Marco

doi:10.1002/j.1552-4604.1984.tb01833.x

Cited by 72 publications

(20 citation statements)

References 18 publications

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“…Intraoperative blood Blood loss in the Additional blood loss Additional blood loss loss, ml recovery room, ml until first postoperative until first postoperative morning, ml evening, ml ALBn =481 400 (400-3500) 1000 (200-2600) 300 (0-1100) 100 (0-570) HES n=53 1200 (400-8300) 1150 (300-3400) 300 (0-1000) 150 (0-600) The findings concerning HES in the present study are in accordance with a previous study in volunteers where a small dose of a low molecular weight HES (125 kDa) with high substitution ratio (0.7) caused no, or only minimal changes in blood coagulation (13). However, had a larger dose of HES had been given, a decrease in coagulation factor levels might have been seen (14).…”

Section: Groupsupporting

confidence: 91%

Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty

2005

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Background and Aims: Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients.Material and Methods: 101 patients undergoing primary hip arthroplasty received in random order 4%albumin (n =48) or HES (average M w 120 kDa/molar substitution ratio 0.7, n=53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6-8 %, 12-16 %, 60 % and 100 % blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis.Results and Conclusions: Administration of albumin or HES 1200 ml (500-2000 and 500-1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.

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Section: Groupsupporting

confidence: 91%

Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty

2005

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“…Previous studies have reported a reduction in cerebral infarct size with the use of these agents 8,12) and improvement in cerebral blood flow in ischemic as well as normal brain 6,19) . Although the etiology Coagulopathy with the Use of Hydroxyethyl Starch｜SH Hwang, et al of this improvement was unclear, they suggested theories including hemodilution, decreased plasma viscosity, increased cardiac output, or mild elevation of clotting time 7,12,20) . The mild elevation of clotting time was ascribed to precipitation by hetastarch of factor VIII 5,7,10,15) .…”

Section: Discussionmentioning

confidence: 99%

“…Although the etiology Coagulopathy with the Use of Hydroxyethyl Starch｜SH Hwang, et al of this improvement was unclear, they suggested theories including hemodilution, decreased plasma viscosity, increased cardiac output, or mild elevation of clotting time 7,12,20) . The mild elevation of clotting time was ascribed to precipitation by hetastarch of factor VIII 5,7,10,15) . Studies in humans used doses lower than those necessary for the treatment of vasospasm in normal volunteers 8,15) .…”

Section: Discussionmentioning

confidence: 99%

A Comparative Coagulopathic Study for Treatment of Vasospasm by Using Low- and High-molecular Weight Hydroxyethyl Starches

Hwang

Won

et al. 2007

J Korean Neurosurg Soc

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Objective : High-molecular-weight hydroxyethyl starch (HES) compromises blood coagulation more than does low-molecular-weight HES. We compared the effects of low-and high-molecular-weight HES for the treatment of vasospasm and investigated the dose relationship with each other. Methods : Retrospectively, in a series of consecutive 102 patients with subarachnoid hemorrhage (SAH), 35 patients developed clinical symptoms of vasospasm of these fourteen patients were treated with low-molecularweight HES for volume expansion while the other 21 received high-molecular-weight HES as continuous intravenous infusion. Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen level, and platelet count were all measured prior to initiation, during treatment and after termination of therapy for symptomatic vasospasm. The total dose of HES ranged from 5 L to 14 L and median infusion duration was 10 days. Results : A more pronounced PTT prolongation was observed in high-molecular-weight HES group compared with low-molecular-weight HES group. No other coagulation parameters were altered. Dosage (=duration) shows a positive correlation with PTT. Clinically, significant bleeding episodes were noted in four patients who received high-molecular-weight HES. Conclusion : Coagulopathy was developed in direct proportion to molecular weight of starch and dosages. We propose the extreme caution in the administration of HES solution for the vasospasm treatment.

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“…wt. 70000) infusion [13]. The hemodynamic effects of hetastarch have been found to be comparable to those of a 5% albumin solution [14,32].…”

Section: Introductionmentioning

confidence: 92%

“…Hetastarch seems to cause only minor changes in laboratory parameters; it is nontoxic and nonallergenic in doses of up to 6 g/kg in dogs [14]. However, in excessive doses hetastarch has been found to decrease factor VIII values and it produces prolongation of the bleeding time [5,13]. The frequency of severe anaphylactoid reactions has been 0.006% for hetastarch [29].…”

Section: Introductionmentioning

confidence: 97%

Correction of hemorrhagic shock-induced liver hypoxia with whole blood, Ringer's solution or with hetastarch

et al. 1989

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Liver oxygenation was studied with hemorrhagic hypotension and corrected using whole blood, a synthetic colloid (hydroxyethyl starch or hetastarch, HES; mol. wt. 120,000), or a crystalloid solution. Measurements were performed directly by recording pig liver tissue oxygen tension with an implanted silicone elastomer (Silastic) tube, and indirectly by calculating blood oxygen contributions. The direct method seems fairly reliable and accurately reflects different levels of bleeding and shock and their correction. Liver tissue oxygen tension (PlO2) may thus be used as an indicator of central organ response to shock management. PlO2 decreased during bleeding from 33.5 +/- 0.5 to 16.0 +/- 0.5 torr, and normalized rapidly after retransfusion. The baseline values were significantly exceeded after hetastarch infusion but were never reached with Ringer's solution. The correction of liver oxygen consumption was less complete after crystalloid infusion as well. On the other hand, the difference in liver oxygenation was less marked after crystalloid infusion and retransfusion, which restored perfusion to the baseline. The total amount of Ringer's solution needed to keep the animals hemodynamically stable during the 2-h follow-up period was four times higher than with hetastarch and some five times the blood volume shed. The cause of defective correction of liver oxygenation seems to be the poor response of liver blood flow to refilling in the Ringer group, in addition to apparent tissue edema after crystalloid infusion. According to our study, hemorrhagic hypotension related to liver oxygenation is more promptly and completely corrected with the colloid hydroxyethyl starch than with a crystalloid solution in the early phase of treatment.

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Effect of Hydroxyethyl Starch and Dextran on Plasma Volume and Blood Hemostasis and Coagulation

Cited by 72 publications

References 18 publications

Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty

Albumin Induced Hypercoagulability Does Not Reduce Blood Loss in Patients Undergoing Total HIP Arthroplasty

A Comparative Coagulopathic Study for Treatment of Vasospasm by Using Low- and High-molecular Weight Hydroxyethyl Starches

Correction of hemorrhagic shock-induced liver hypoxia with whole blood, Ringer's solution or with hetastarch

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