Highly Substituted Hydroxyethyl Starch (HES 200/0.62) Leads to Type-l von Willebrand Syndrome after Repeated Administration

Treib, J.; Haaß, A.; Pindur, G.; Miyachita, C.; Grauer, M; Jung, F; Wenzel, E.; Schimrigk, К.

doi:10.1159/000217209

Cited by 19 publications

(23 citation statements)

References 15 publications

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“…Despite the administration of a total of 450 g HES, none of the coagulation parameters studied were influenced by HES 40 beyond the dilu tion effect. A comparable study demonstrated that the infusion of HES 200/0.62, with an in vivo MW twice as large, caused a drop below the hemostasiological limit of 30% for the fac tor VIII/von Willebrand complex [6],…”

Section: Discussionmentioning

confidence: 91%

“…Recently, Trumble et al [4] reported a clinically rele vant coagulopathy after the use of hetastarch in the treatment of subarachnoid hemorrhagic vasospasm [5]. Hemostasiological studies showed that these hemorrhages were due to an acquired type I von Willebrand syndrome [6]. Strauss et al [7] observed that medium MW HES (Pentastarch, MW 264 kD) alters coagulation much less than high MW starch.…”

Section: Introductionmentioning

confidence: 99%

“…HES 200/0.62 with its large in vivo MW of 120 kD increases plasma viscosity significantly. An 80% reduction in factor VUI/von Willebrand factor explains the increase in hemorrhagic diathesis [6], On the other hand, HES 200/0.5 with an in vivo MW of 37 kD lowered erythrocyte aggrega tion and plasma viscosity significantly, but during a hemodilution therapy it leads to no clinically relevant impairment of coagulation Low Molecular Weight HES and Hemostasis [9,10], These studies demonstrate that the in vitro MW alone is not the sole indicator of clinical efficacy. Additional information about the degree of substitution and the C2/ C6 ratio would improve the characterization of HES.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Low Molecular Weight Hydroxyethyl Starch (HES 40/0.5-0.55) on Hemostasis and Hemorheology

Treib

Haaß²,

Pindur³

et al. 1996

Pathophysiol Haemos Thromb

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Hydroxyethyl starch (HES) with a high or medium molecular weight (MW) and a high degree of substitution is difficult to degrade and leads to an accumulation of large molecules. These molecules have a negative effect on hemostasiological parameters. In 10 patients with cerebrovascular diseases, a hemodilution therapy was carried out with low MW HES for 10 days. Due to the low MW of the HES used (56-61 kD), the rheological parameters erythrocyte aggregation and plasma viscosity were significantly lowered (p < 0.01). No coagulation parameters studied were affected beyond the dilution effect, which was measured using the decline in hematocrit. Low MW starch is a volume substitute that is well-suited for repeated infusion or hemodilution therapy, particularly for patients with increased hemorrhagic diathesis, because it does not affect hemostasis. The disadvantage of a relatively short volume effect can be compensated through a continuous infusion of a larger volume.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Low Molecular Weight Hydroxyethyl Starch (HES 40/0.5-0.55) on Hemostasis and Hemorheology

Treib

Haaß²,

Pindur³

et al. 1996

Pathophysiol Haemos Thromb

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“…aPTT may also be slightly influenced by the low-dose heparin treatment. The results of the analysis of the different subunits of the von Willebrand factor VIII, which are known to be diminished by HMW HES in vivo, result ing in an acquired von Willebrand syndrome [14,15,25], show no significant or clinically relevant change.…”

Section: Discussionmentioning

confidence: 99%

No Coagulation Disorders under High-Dose Volume Therapy with Low-Molecular-Weight Hydroxyethyl Starch

Stoll

Treib²,

Schenk³

et al. 1997

Pathophysiol Haemos Thromb

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Hydroxyethyl starch (HES) is often used for volume therapy. Since bleeding complications have been reported repeatedly, a strict dose limitation of a maximum of 1,500 ml 6% solution per day is recommended. However, many indications require higher dosages. Bleeding complications are known to be caused by an acquired von Willebrand syndrome. It has been shown that the accumulation of large molecules and their impairment in the coagulation system can be avoided by using HES preparations with a low in vivo molecular weight. However, the effects of a high-dose therapy have not been studied yet. We have investigated, how a 4-day high-dose therapy, using 3,000 ml 6% HES 70/0.5 on the 1st day and 1,500 ml on days 2-4, affects the coagulation system and hemorheological parameters of acute stroke patients. Thromboplastin time, activated partial thromboplastin time and thrombin time showed no significant changes, except for a slight, clinically irrelevant change due to dilution. The subunits of von Willebrand factor VIII showed no significant change. Hematocrit decreased from 42.3 ± 4.6 to 37.4 ± 3.9% (p < 0.05) after day 1, reaching 35.3 ± 4.2% (p < 0.01) at the end of the therapy, demonstrating a substantial volume effect. Plasmaviscosity and erythrocyte aggregation decreased slightly, however not significantly. Our study shows that even a high-dose therapy with 6% HES 70/0.5 has no influence on the coagulation system.

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“…63 Several studies have shown that infusion of colloid plasma expanders induces coagulopathy to a greater extent than simple dilution, thereby increasing the risk of bleeding. 53,54,64 Several mechanisms have been proposed: some studies have shown that colloids may reduce levels of von Willebrand factor (vWF) and factor VIII, 65,66 whereas other studies have reported on masked expression of glycoprotein IIb/IIIa on activated platelets. 67,68 More recently, an acquired deficiency of fibrinogen with abnormal fibrin polymerization have been proposed as the main determinant of dilutional coagulopathy.…”

Section: Dilutionmentioning

confidence: 99%

New insights into acute coagulopathy in trauma patients

Ganter

Pittet

2010

Best Practice & Research Clinical Anaesthesiology

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Abnormal coagulation parameters can be found in 25% of trauma patients with major injuries. Furthermore, trauma patients presenting with coagulopathy on admission have worse clinical outcome. Tissue trauma and systemic hypoperfusion appear to be the primary factors responsible for the development of acute traumatic coagulopathy immediately after injury. As a result of overt activation of the protein C pathway, the acute traumatic coagulopathy is characterised by coagulopathy in conjunction with hyperfibrinolysis. This coagulopathy can then be exacerbated by subsequent physiologic and physical derangements such as consumption of coagulation factors, haemodilution, hypothermia, acidemia and inflammation, all factors being associated with ongoing haemorrhage and inadequate resuscitation or transfusion therapies. Knowledge of the different mechanisms involved in the pathogenesis of acute traumatic coagulopathy is essential for successful management of bleeding trauma patients. Therefore, early evidence suggests that treatment directed at aggressive and targeted haemostatic resuscitation can lead to reductions in mortality of severely injured patients. ABSTRACTAbnormal coagulation parameters can be found in 25% of trauma patients with major injuries. Furthermore, trauma patients presenting with coagulopathy on admission have worse clinical outcome. Tissue trauma and systemic hypoperfusion appear to be the primary factors responsible for the development of acute traumatic coagulopathy immediately after injury. As a result of overt activation of the protein C pathway, the acute traumatic coagulopathy is characterized by coagulopathy in conjunction with hyperfibrinolysis. This coagulopathy can then be exacerbated by subsequent physiologic and physical derangements like consumption of coagulation factors, hemodilution, hypothermia, acidemia, and inflammation; all factors being associated with ongoing hemorrhage and inadequate resuscitation or transfusion therapies. Knowledge of the different mechanisms involved in the pathogenesis of acute traumatic coagulopathy is essential for successful management of bleeding trauma patients. Therefore, early evidence suggests that treatment directed at aggressive and targeted hemostatic resuscitation can lead to reductions in mortality of severely injured patients.

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Highly Substituted Hydroxyethyl Starch (HES 200/0.62) Leads to Type-l von Willebrand Syndrome after Repeated Administration

Cited by 19 publications

References 15 publications

Influence of Low Molecular Weight Hydroxyethyl Starch (HES 40/0.5-0.55) on Hemostasis and Hemorheology

Influence of Low Molecular Weight Hydroxyethyl Starch (HES 40/0.5-0.55) on Hemostasis and Hemorheology

No Coagulation Disorders under High-Dose Volume Therapy with Low-Molecular-Weight Hydroxyethyl Starch

New insights into acute coagulopathy in trauma patients

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