Gelatin Use Impairs Platelet Adhesion during Cardiac Surgery

Tabuchi, Noriyuki; Dehaan, J; Huet, Rcgg; Boonstra, PW; Vanoeveren, W

doi:10.1055/s-0038-1649963

Cited by 79 publications

(52 citation statements)

References 23 publications

(12 reference statements)

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“…In addition the anti-inflammatory effects of HES may be the result of an effective fluid resuscitation [15] . GL has similar effects on coagulation and thrombocyte function as the other colloids tested [16][17][18] . No data are published about the effects of GL on EDR.…”

Section: Discussionmentioning

confidence: 71%

Effects of Hydroxyethyl Starch, Gelatin and Dextran on Endothelium-Derived Relaxation in Porcine Coronary Arteries

Dagtekin¹,

Klisa

Gerbershagen

et al. 2010

Pharmacology

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Background: In a pilot study we could show that hydroxyethyl starch (HES) induced a significant reduction of endothelium-dependent relaxation (EDR) and the endothelium-derived hyperpolarizing factor (EDHF). In this follow-up study we investigated whether this effect of HES was dose-dependent and whether it could be replicated with other colloids like dextran (DX) and gelatin (GL). Methods: Rings of fresh porcine coronary arteries were consecutively tested with or without HES, DX or GL (5, 10, or 20 mg/ml). Indomethacin was added in all measurements to eliminate prostacyclin effects. Prostaglandin F₂α was used for contraction and bradykinin (BK, 10^–10 to 10^–5M) for inducing EDR. After blocking nitric oxide (NO) by N-nitro-L-arginine (L-NNA), the experiments were repeated to assess the EDHF-mediated relaxation response to BK. Results: HES induced a reduction in EDR for the BK concentrations of 10^–8 and 10^–7M (n = 10; p < 0.05). After NO blockage with L-NNA, the relaxation response was reduced especially for the BK concentrations of 10^–6 and 10^–5M (p < 0.05). GL showed a reduction in EDR with or without NO blockage with L-NNA especially for the BK concentrations of 10^–6 and 10^–5M (n = 14; p < 0.05). DX induced a significant reduction in EDR for the BK concentrations of 10^–7 and 10^–6M (n = 12; p < 0.05). After NO blockage with L-NNA, the relaxation response was reduced especially for the BK concentrations of 10^–6 and 10^–5M (p < 0.05). Conclusion: For clinically relevant concentrations of HES, DX and GL a significant reduction in both NO-induced and NO-/prostacyclin-independent EDR can be found in epicardial coronary arteries of the pig.

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Section: Discussionmentioning

confidence: 71%

Effects of Hydroxyethyl Starch, Gelatin and Dextran on Endothelium-Derived Relaxation in Porcine Coronary Arteries

Dagtekin¹,

Klisa

Gerbershagen

et al. 2010

Pharmacology

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“…Gelatin in vitro also decreases the clot strength, but to a lesser degree than rapidly degradable HES solution [113]. Gelatin has also been observed to interfere with platelet aggregation and to impair clot strength in patients undergoing cardiac surgery without an effect on blood loss [114][115][116][117][118][119].…”

Section: Coagulationmentioning

confidence: 99%

Colloid solutions: a clinical update

2010

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Albumin, dextran, gelatin, and hydroxyethyl starch (HES) solutions are colloids that efficiently expand the circulating blood volume. The administration of colloids restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone. However, colloids are always given for surgical and critically ill patients. The type of the colloid, volumes applied, aggressiveness of fluid resuscitation, and the volume status at the initial phase of administration determine their clinical responses. The outcome after fluid resuscitation with various colloids in critically ill patients seems to be comparable according to systematic reviews. A randomized, adequately powered clinical trial comparing modern nonprotein colloid to albumin is still lacking. Rapidly degradable HES solutions have good hemodynamic effects, and the risk of adverse renal and coagulation effects, as well as allergic reactions, is minimal. The current investigation has also shown the beneficial effect of HES solution (especially HES 130/0.4) on inflammatory response, postoperative nausea and vomiting, and postoperative outcome. The indication of colloids with an assessment of the degree of hypovolemia and safety profiles should thus be taken into consideration before colloid administration.

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“…Gelatin is known to affect platelet function and blood coagulation adversely [39]. For instance, a linear correlation has been demonstrated (p < 0.002) between volume of administered gelatin in the 2000-4000 mL range and volume of postoperative blood loss in cardiac surgery patients [63]. Additionally, in a randomized trial, gelatin reduced factor VIII-vWF complex levels during CPB as compared with albumin (p = 0.002) [64,65].…”

Section: Hes 130/04 Vs Gelatinmentioning

confidence: 99%

Hydroxyethyl starch – can the safety problems be ignored?

Wiedermann

2004

Wien Klin Wochenschr

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Hydroxyethyl starch (HES) has come into widespread use for fluid management of acutely ill patients. Certain characteristic complications of HES, notably renal impairment, hemorrhage and pruritus, have been well documented with all types of HES solutions. The use of HES solutions with lower molecular weight and substitution has been claimed to minimize these safety risks. In particular, solutions of 200 kDa molecular weight and 0.5 substitution (HES 200/0.5) and of 130 kDa molecular weight and 0.4 substitution (HES 130/0.4) have been advocated for their superior safety profile. A critical appraisal of the available evidence does not provide reassurance that these or other HES solutions are risk free. Most evidence indicates the equivalence of HES 200/0.5 and HES 130/0.4 with respect to effectiveness for volume expansion. Since HES 130/0.4 is newer, its safety profile is less well characterized; however, it appears to share the same complication risks as those of HES 200/0.5. In randomized clinical trials employing sensitive markers, both HES 200/0.5 and HES 130/0.4 have been shown to impair renal function. Both coagulopathy and clinical bleeding have been documented after administration of either HES 200/0.5 or HES 130/0.4, and the magnitude of negative effects on hemostasis has been similar for these two HES solutions. Pruritus is a common side effect of all HES solutions, including HES 200/0.5 and HES 130/0.4, and can occur in diverse clinical settings in some cases after only small HES doses. Typically presenting as pruritic crises of delayed onset, this complication is often severe, protracted and refractory to treatment. An additional risk of HES infusion is the occurrence of potentially life-threatening anaphylactoid reactions, which are 4.5 times as frequent after HES as albumin exposure. Limiting the dose and duration of HES therapy may be helpful in lessening the risk of undesired side effects; at present however, reliance on particular HES solutions does not appear sufficient to ensure safety.

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Gelatin Use Impairs Platelet Adhesion during Cardiac Surgery

Cited by 79 publications

References 23 publications

Effects of Hydroxyethyl Starch, Gelatin and Dextran on Endothelium-Derived Relaxation in Porcine Coronary Arteries

Effects of Hydroxyethyl Starch, Gelatin and Dextran on Endothelium-Derived Relaxation in Porcine Coronary Arteries

Colloid solutions: a clinical update

Hydroxyethyl starch – can the safety problems be ignored?

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