Effect of the colloids gelatin and HES 130/0.4 on blood coagulation in cardiac surgery patients: a randomized controlled trial

Kimenai, DM; Bastianen, GW; Daane, C R; Megens-Bastiaanse, CM; Meer, Njm van der; Scohy, TV; Gerritse, BM

doi:10.1177/0267659113491446

Cited by 17 publications

(19 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…24-26 Ten studies were included in our systematic review for qualitative and quantitative analysis. 27-36 For the comparison between gelatin and HES, 6 studies were found; 27-32 for the comparison between gelatin and crystalloids, 4 studies were included. 33-36 Study characteristic tables of all included full-text articles can be found in the supplementary material (supplementary material can be found online with this article).…”

Section: Resultsmentioning

confidence: 99%

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

2017

View full text Add to dashboard Cite

This systematic review and meta-analysis was conducted to evaluate the safety of gelatin versus hydroxyethyl starches (HES) and crystalloids when used for cardiopulmonary bypass (CPB)-priming in cardiac surgery. MEDLINE (Pubmed), Embase and CENTRAL were searched. We included only randomized, controlled trials comparing CPB-priming with gelatin with either crystalloids or HES-solutions of the newest generation. The primary endpoint was the blood loss during the first 24 hours. Secondary outcomes included perioperative transfusion requirements, postoperative kidney function, postoperative ventilation times and length of stay on the intensive care unit. Sixteen studies were identified, of which only ten met the inclusion criteria, representing a total of 824 adult patients: 4 studies compared gelatin with crystalloid, and 6 studies gelatin with HES priming. Only 2 of the studies comparing HES and gelatin reported postoperative blood loss after 24 hours. No significant difference in postoperative blood loss was found when results of both studies were pooled (SMD -0.12; 95% CI: -0.49, 0.25; P=0.52). Likewise, the pooled results of 3 studies comparing gelatin and crystalloids as a priming solution could not demonstrate significant differences in postoperative bleeding after 24 hours (SMD -0.07; 95% CI: -0.40, 0.26; P=0.68). No differences regarding any of the secondary outcomes could be identified. This systematic review suggests gelatins to have a safety profile which is non-inferior to modern-generation tetrastarches or crystalloids. However, the grade of evidence is rated low owing to the poor methodological quality of the included studies, due to inconsistent outcome reporting and lack of uniform endpoint definitions.

show abstract

Section: Resultsmentioning

confidence: 99%

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

2017

View full text Add to dashboard Cite

show abstract

“…The characteristics of the 22 included RCTs are shown in Table 1 . Of these, 14 RCTs reported patients who had undergone complex surgical procedures needing volume expansion therapy in the ICU [ 22 - 35 ], and 8 RCTs reported patients with other diseases (such as cardiac arrest, trauma, and so on) who received volume expansion therapy in the ICU [ 6 , 36 - 42 ]. Two RCTs reported data for a non-septic subgroup [ 6 , 38 ], and we included these data.…”

Section: Resultsmentioning

confidence: 99%

“…Among our included articles, 14 RCTs [ 6 , 23 - 27 , 32 , 34 , 36 , 38 - 42 ] reported the overall mortality; 9 RCTs [ 24 - 27 , 31 , 34 , 37 , 41 , 42 ] reported the incidence of RRT; 10 RCTs [ 22 - 24 , 27 - 31 , 33 , 35 ] reported bleeding volume after surgery; 10 RCTs [ 22 , 24 - 28 , 30 , 31 , 33 , 35 ] reported RBC transfusion after surgery; and 9 RCTs [ 23 , 27 - 30 , 32 , 33 , 37 , 42 ] reported fluid application during the first day in ICU (Additional file 2 : Table S1). According to the modified Jadad score, high quality was determined in 13 studies, and low quality was determined in 9 studies (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials

et al. 2015

Crit Care

View full text Add to dashboard Cite

IntroductionUse of hydroxyethyl starch (HES) in septic patients is reported to increase the mortality and incidence of renal replacement therapy (RRT). However, whether or not use of HES would induce the same result in non-septic patients in the intensive care unit (ICU) remains unclear. The objective of this meta-analysis was to evaluate 6% HES versus other fluids for non-septic ICU patients.MethodsRandomized controlled trials (RCTs) were searched from Pubmed, OvidSP, Embase database and Cochrane Library, published before November, 2013. A meta-analysis was made on the effect of 6% HES versus other fluids for non-septic ICU patients, including mortality, RRT incidence, bleeding volume, red blood cell (RBC) transfusion and fluid application for non-septic patients in ICU.ResultsTwenty-two RCTs were included, involving 6,064 non-septic ICU patients. Compared with the other fluids, 6% HES was not associated with decreased overall mortality (RR = 1.03, 95%CI: 0.09 to 1.17; P = 0.67; I2 = 0). There was no significant difference in RRT incidence, bleeding volume and red blood cell transfusion between 6% HES group and the other fluid groups. However, patients in HES group received less total intravenous fluids than those receiving crystalloids during the first day in ICU (SMD = −0.84; 95%CI: −1.39 to −0.30; P = 0.003, I2 = 74%).ConclusionsThis meta-analysis found no increased mortality, RRT incidence, bleeding volumes or RBC transfusion in non-septic ICU patients, but the sample sizes were small and the studies generally were of poor quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0833-9) contains supplementary material, which is available to authorized users.

show abstract

“…Two limitations included the potential bias of time and contamination of the gelatin group with HES prime fluid during cardiopulmonary bypass. Other smaller studies were not able to identify differences in clinical outcomes between fluid types, either gelatin compared to HES or crystalloid (73,74,76,(135)(136)(137)(138)(139)(140). There are two exceptions concerning studies in cardiac surgical patients.…”

Section: Gelatinmentioning

confidence: 99%

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

Effect of the colloids gelatin and HES 130/0.4 on blood coagulation in cardiac surgery patients: a randomized controlled trial

Abstract: In this randomized, controlled trial of adults after on-pump CABG procedures, there was no significant difference in blood loss or blood coagulation between the HES group and the Gelo group.

Cited by 17 publications

References 23 publications

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Safety of gelatin solutions for the priming of cardiopulmonary bypass in cardiac surgery: a systematic review and meta-analysis

Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials

Intravenous Fluid Administration and the Coagulation System

Contact Info

Product

Resources

About