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

Treib, J.; Haaß, A.; Pindur, G.; Grauer, M; Seyfert, U. T.; Treib, Wolfgang; Wenzel, E.; Schimrigk, К.

doi:10.1159/000217216

Cited by 18 publications

(24 citation statements)

References 10 publications

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“…The in vivo Mw for medium substituted HES (MS = 0.5) was measured around 60 kDa. Using HES (200/0.5) this in vivo Mw is reached quite fast after infusion [1]. The equilibrium of in vitro and in vivo Mw of HES (70/0.5) is random.…”

Section: Discussionmentioning

confidence: 96%

“…A reference value for this amount of HES molecules is the Bf10% (10% of infused molecules are smaller than this molecular mass). Additionally, enzymatic degradation beginning from the outer molecular chains [1] is only possible in glycosidic bonds that are not substituted [6]. The splitting of parts of HES molecules is assumed to be representative for the whole molecule [5].…”

Section: Discussionmentioning

confidence: 99%

“…It is assumed that there is a lower incidence of impairment of coagulation as well as less itching than after application of equally substituted HES of higher Mw (200/0.5) [1]. The incidence of side effects should depend on the amount of high Mw HES, which is larger for HES (200/0.5) than for HES (70/0.5).…”

Section: Introductionmentioning

confidence: 99%

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Pharmacokinetics of Hydroxyethyl Starch (70/0.5) following Repeated Infusions

Lehmann¹,

Asskali²,

Förster³

2003

Transfus Med Hemother

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Background: For the purpose of haemodilution different medium substituted hydroxyethyl starches (HES) are available. These plasma substitutes can be further characterized by their average molecular weight (Mw) into medium Mw (HES 200/0.5) and low Mw (HES 70/0.5) starches. Patients and Methods: Pharmacokinetic data were collected in a trial with a design similar to clinical use. 8 healthy volunteers were given 50 g HES on 5 consecutive days (=250 g) to estimate the in vivo changes of the chemical structures of HES (70/0.5). Results: Calculated half-life of serum elimination were 6–10 h which was representative for medium substituted HES and the chosen infusion scheme. The mild accumulation of HES (70/0.5) should be without clinical relevance. The in vivo Mw is equivalent to the in vitro Mw of the infused HES (70/0.5). The in vivo Mw is about 60,000 Dalton for most medium substituted HES. Nevertheless, regarding molar substitution and pattern of substitution (C2:C6) there are some differences between applied HES (70/0.5) and HES recovered in urine. These changes also indicate a shift in the chemical properties of infused HES in the organism. Only 60% of infused HES were recovered in urine. The destination of the remaining 40% (∼100 g in this clinical trial) is still unexplained. A fractional amount might be stored in the reticuloendothelial system. Concerning the measured data of medium substituted HES (70/0.5) it stands to reason that differences in the approximate substituted HES (200/0.5) with a higher molecular weight are without clinical relevance. Conclusion: The in vivo Mw is independent of the in vitro Mw of the applied HES. Pharmacokinetic data suggest that HES (70/0.5) is a good option for the purpose of haemodilution.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Pharmacokinetics of Hydroxyethyl Starch (70/0.5) following Repeated Infusions

Lehmann¹,

Asskali²,

Förster³

2003

Transfus Med Hemother

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“…The C2/C6 ratio describes the ratio of hydroxyethyl groups substituted at the C2 and C6 positions of the glucose molecules of starch. These characteristics are also important for the blood coagulation compromising potency [15] in that the higher the molecular weight [16,17], the higher the degree of substitution [18][19][20] and the higher the C2/C6 ratio [21], the greater is the effect of an HES solution on blood coagulation. The HES solutions investigated in the present study are identical with regard to molecular weight (200 000) and degree of substitution (0.5) but differ with regard to the C2/C6 ratio, in that potato starch derived HES has a C2/C6 ratio of 6.5 : 1 and corn starch derived HES has a C2/C6 ratio of 5.1 : 1 [14].…”

Section: Discussionmentioning

confidence: 99%

The effect of potato starch derived and corn starch derived hydroxyethyl starch on in vitro blood coagulation

Jamnicki¹,

Zollinger²,

Seifert

et al. 1998

Anaesthesia

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SummaryWe have compared the effects of progressive in vitro haemodilution (30% and 60%) with potato starch derived hydroxyethyl starch and corn starch derived hydroxyethyl starch on blood coagulation in 80 patients using thrombelastography. Both solutions significantly compromised blood coagulation as evidenced by an increase in coagulation time and decreases in angle a, maximum amplitude and coagulation index (p < 0.05). Blood coagulation was more compromised during haemodilution with potato starch derived hydroxyethyl starch as compared with corn starch derived hydroxyethyl starch (p < 0.05). When taking the effect of haemodilution with 0.9% saline into account, haemodilution with both hydroxyethyl starch solutions also augmented clot lysis (p < 0.05), with potato starch derived hydroxyethyl starch having a greater effect than corn starch derived hydroxyethyl starch (p < 0.05). We conclude that potato starch derived hydroxyethyl starch compromises in vitro blood coagulation more than corn starch derived hydroxyethyl starch. Avoiding allogeneic blood transfusion has become an important issue in surgery and intensive care medicine with increasing awareness of the potential side-effects [1,2]. Besides transmission of infectious diseases, the increased incidence of postoperative infections with prolonged hospitalisation and increased costs [3] has recently created much interest. As a consequence, allogeneic blood transfusions are being withheld longer and volume replacement is performed using larger quantities of crystalloids and colloids. However, crystalloids and colloids affect blood coagulation, inducing hypercoagulable and hypocoagulable states [4][5][6][7]. Knowledge of the effects of different colloids on blood coagulation is therefore of clinical relevance.The present study was designed to investigate the effects on in vitro blood coagulation of a newly developed potato starch derived hydroxyethyl starch (HES) and to compare these effects with those of the traditional corn starch derived HES, as assessed by thrombelastography (TEG) [6,7]. Since it is important to differentiate between a haemodilutional effect per se and an intrinsic colloidal effect of different HES solutions, we simultaneously compared TEG parameters of native blood, blood diluted with 0.9% saline and blood diluted with potato starch derived HES and corn starch derived HES. Methods

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“…However, when administering these substances, one has to take into account recent studies which have shown that dextrans and highly substituted hydroxyethyl starches, when they are used for a volume therapy lasting for several days, can lead to hemorrhagic complications. This can be avoided by using hydroxyethyl starch with a low in vivo MW (HES 200/0.5 or 70/0.5) [31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler Monitoring of Intracranial Pressure Therapy with Mannitol, Sorbitol and Glycerol in Patients with Acute Stroke

et al. 1998

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Introduction: The noninvasive management of the conservative therapy for intracranial pressure (ICP) with hyperosmolar substances is a central problem in the treatment of brain edema. Using transcranial Doppler (TCD), a continuous monitoring of ICP is now possible, because the TCD pulsatility index (PI) intraindividually closely correlates with the level of ICP. Patients and Methods: We administered an ICP-lowering treatment 113 times in 10 patients with intracranial bleeding or ischemic stroke who also had signs of elevated ICP in the computer tomogram. The treatment was carried out over a period of 9 days, using 50 g each of intravenous sorbitol (n = 38) and mannitol (n = 32) or oral glycerol (n = 43). Results: PI was significantly lowered between 20.0 and 23.9% (p < 0.01) by all substances in the affected and unaffected sides. The differences between the three substances and the differences between the affected and unaffected sides were not significant. The duration of the therapeutic effect of glycerol (190 ± 41 min) was significantly longer (p < 0.01) than that of sorbitol (150 ± 28 min) or mannitol (130 ± 20 min). The duration of the therapeutic effect was also significantly shorter (p < 0.01) in patients with a high PI (> 1.5). All three substances led to a significant increase (p < 0.01) in minimal (= diastolic) flow velocity (V_min). The increase was highest for glycerol (56.3 ±72.6%). Summary: The decrease in PI under therapy was caused by an increase in V_min. This indicates that ICP therapy with hyperosmolar substances improves brain edema and does not suggest a therapy-induced vasoconstriction.

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

Cited by 18 publications

References 10 publications

Pharmacokinetics of Hydroxyethyl Starch (70/0.5) following Repeated Infusions

Pharmacokinetics of Hydroxyethyl Starch (70/0.5) following Repeated Infusions

The effect of potato starch derived and corn starch derived hydroxyethyl starch on in vitro blood coagulation

Transcranial Doppler Monitoring of Intracranial Pressure Therapy with Mannitol, Sorbitol and Glycerol in Patients with Acute Stroke

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