All medium starches are not the same: Influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation

Treib, J.; Haaß, A.; Pindur, G.; Grauer, M; Wenzel, E.; Schimrigk, К.

doi:10.1046/j.1537-2995.1996.36596282590.x

Cited by 159 publications

(114 citation statements)

References 19 publications

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“…18 The effects of starches on coagulation appeared closely related to their in vivo molecular weight. 18,19 These different effects on coagulation cannot be detected by routine coagulation tests.…”

Section: Discussionmentioning

confidence: 99%

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

et al. 2004

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P Pu ur rp po os se e: : To compare the efficacy of volume expansion with 3.5% gelatin and 6% hydroxyethyl starch 200/0.5 in patients undergoing cardiac surgery. The second objective was to compare the two colloids in terms of blood losses and allogeneic blood transfusion exposure rate. M Me et th ho od ds s: :In this open-label controlled study, patients were randomly allocated to receive either 3.5% urea-linked gelatin (GEL group: n = 55) or 6% hydroxyethyl starch 200/0.5/5.1 (HES group: n = 55) for per-(including priming of the bypass machine) and postoperative volume management with a maximum dosage of 30 ± 3 mL·kg -1 ·day -1 . Volume replacement was guided according to routine per-and postoperative care based on cardiac index, mixed venous oxygen saturation, and diuresis. If additional colloid was required, 4.5% albumin had to be given. The study period comprised per-and postoperative investigations up to 18 hr after surgery. R Re es su ul lt ts s: : All hemodynamic variables were comparable in both groups. Total study drug was 25.8 ± 4.8 mL·kg -1 in the GEL group and 24.5 ± 6.0 mL·kg -1 in the HES group. There was no difference in the number of patients receiving albumin solution or in the amount of albumin administered. Total blood loss was higher in the HES than in the GEL group (11.0 ± 7.8 mL·kg -1 vs 8.7 ± 4.0 mL·kg -1 ; P < 0.05) resulting in a higher need for allogeneic blood transfusion (HES: nine patients received 12 units, GEL two patients received 3 units; P = 0.026).C Co on nc cl lu us si io on n: : In the conditions of the present study, HES was not associated with a better plasma expansion effect than GEL. HES could result in a higher need for allogeneic blood transfusion. 'HEA qu'avec la GEL (11,0 ± 7,7 ± 4,[0][1] P < 0,05) Objectif

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Section: Discussionmentioning

confidence: 99%

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

et al. 2004

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“…These inconsistent outcomes could be due to differences in animal age and animal species used; different anesthetics, methods, and tracers used to measure vascular permeability; the time at which postischemic edema assessments were made; the dose administered as well as other intrinsic property differences between the various HES compounds 30 ; and the extent to which HES and HES-like compounds affected hematocrit, blood viscosity, and autoregulatory capacity. 30 Moreover, the type and severity of the cerebral ischemic insult and the associated degree of blood-brain barrier compromise, as well as the resultant physiological state of the brain, could also modulate the ability of HES to affect postischemic cerebrovascular integrity. The physiological and hemodynamic changes induced by asphyxia in our model are distinctly different from those induced by global ischemia by cardiac arrest, for example, and these changes may not only affect the integrated response of the tissue but the efficacy of therapeutic measures as well.…”

Section: Discussionmentioning

confidence: 99%

“…However, in models of focal embolic stroke 28 and global ischemia, 29 reductions in edema could not be demonstrated with lowmolecular-weight hetastarch or pentastarch, respectively. These inconsistent outcomes could be due to differences in animal age and animal species used; different anesthetics, methods, and tracers used to measure vascular permeability; the time at which postischemic edema assessments were made; the dose administered as well as other intrinsic property differences between the various HES compounds 30 ; and the extent to which HES and HES-like compounds affected hematocrit, blood viscosity, and autoregulatory capacity. 30 Moreover, the type and severity of the cerebral ischemic insult and the associated degree of blood-brain barrier compromise, as well as the resultant physiological state of the brain, could also modulate the ability of HES to affect postischemic cerebrovascular integrity.…”

Section: Discussionmentioning

confidence: 99%

“…13 Other factors that might contribute to the demonstrated efficacy of HES in our and other preclinical studies relative to human stroke trials showing little or no benefit may also include differential alterations in volume status and differential effects of HES on coagulation and hemorrheology, depending on the degree of substitution and the resultant in vivo molecular weight of the particular HES preparation. 30 In any event, the present in vivo documentation of an anti-inflammatory action of HES reveals one mechanism whereby beneficial effects of this agent might be realized in the setting of global cerebral ischemia. …”

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confidence: 85%

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Hydroxyethyl Starch Reduces Leukocyte Adherence and Vascular Injury in the Newborn Pig Cerebral Circulation After Asphyxia

Kaplan

Park

Gonzales

et al. 2000

Stroke

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Background and Purpose-Hydroxyethyl starch (HES) has beneficial effects on ischemic brain injury; however, its mechanism of action remains unclear. The present study was undertaken to test the hypothesis that HES can attenuate increases in leukocyte adherence and vascular permeability in the cerebral vasculature after global cerebral ischemia induced by asphyxia. Methods-Pial venular leukocyte adherence and permeability to sodium fluorescein were quantified in anesthetized newborn piglets by in situ fluorescence videomicroscopy through closed cranial windows during basal conditions and during 2 hours of reperfusion after global ischemia induced by 9 minutes of asphyxia. Experimental animals received HES after the asphyxial insult (10% HES 257/0.47, 600 mg/kg IV bolus 5 minutes after asphyxia, followed by 600 mg/kg per hour IV drip during reperfusion; nϭ9). Results-A progressive and significant (PϽ0.05) increase in adherent leukocytes was observed during the initial 2 hours of reperfusion after asphyxia compared with nonasphyxial controls. In this model, vascular injury, as determined by significant (PϽ0.05) increases in fluorescein permeability at 2 hours of reperfusion, is largely dependent on adherent leukocytes. HES significantly reduced (PϽ0.05) leukocyte adherence at 1 hour and 2 hours of reperfusion and reduced fluorescein permeability at 2 hours. HES did not change hematocrit or alter pial arteriolar diameter. Conclusions-These findings indicate that a vascular anti-inflammatory action may underlie the beneficial effects of HESin global cerebral ischemia secondary to asphyxia. Since this compound is well tolerated by patients, future preclinical and clinical studies may reveal improvements in functional outcome with the early introduction of this or similar agents after perinatal asphyxia or global ischemia. (Stroke. 2000;31:2218-2223.)Key Words: cerebral ischemia, global Ⅲ inflammation Ⅲ leukocytes Ⅲ reperfusion injury H ydroxyethyl starch (HES) is a clinically well-tolerated complex polysaccharide that has recently been used in the therapeutic treatment of stroke and vasospasm after subarachnoid hemorrhage. It is available in multiple preparations, each with different pharmacological characteristics based on concentration, molecular weight, degree of substitution, and C2/C6 hydroxyethylation ratio. While HES has shown a protective effect with reductions in infarct size and/or improvement in outcome in experimental models of ischemic injury in both central nervous system (CNS) 1-6 and peripheral tissues, 7-10 results of its use in clinical stroke trials have been less encouraging. [11][12][13] This may relate to the time window of administration of the compound relative to stroke onset, as well as the pharmacological characteristics of the particular HES preparation; nevertheless, clinical interest still remains, 14 particularly in situations of elevated intracranial pressure. 15 See Editorial Comment, page 2223The mechanistic basis of the beneficial effects of HES remains unclear. Postulated actions inc...

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“…Such preparations may induce a type I von Willebrand-like syndrome 8 . By contrast, in several studies on humans, modern HES preparations have been used safely without negative effects on hemostasis and bleeding [9][10][11] .…”

Section: Coagulation Alterationsmentioning

confidence: 99%

HES: Is There a Maximal Dose?

Boldt

2001

Transfus Alt Transfus Med

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All medium starches are not the same: Influence of the degree of hydroxyethyl substitution of hydroxyethyl starch on plasma volume, hemorrheologic conditions, and coagulation

Cited by 159 publications

References 19 publications

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

Hydroxyethyl Starch Reduces Leukocyte Adherence and Vascular Injury in the Newborn Pig Cerebral Circulation After Asphyxia

HES: Is There a Maximal Dose?

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