Effect of High- and Low-molecular-weight Low-substituted Hydroxyethyl Starch on Blood Coagulation during Acute Normovolemic Hemodilution in Pigs

Thyes, Caroline; Madjdpour, Caveh; Frascarolo, Philippe; Buclin, Thierry; Bürki, Marco; Fisch, Andreas; Burmeister, Marc-Alexander; Asmis, Lars M.; Spahn, Donat R.

doi:10.1097/00000542-200612000-00023

Cited by 29 publications

(11 citation statements)

References 34 publications

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“…Early studies indicated no amelioration in the TEG‐detectable anomalies when using a 130 kDa product with a degree of substitution of 0.4 (HES 130/0.4) compared with the previous generation (HES 200/0.5) 58 . This was supported by similar findings in a pig model comparing HES 650/0.42 and HES 130/0.43, showing comparably deleterious effects on hemostasis including FVIII/VWF 59 . The in vitro effect of HES 130/0.42 is not reversible by the addition of fibrinogen, 60 which appears compatible with an effect on FVIII/VWF.…”

Section: Safety Of the Synthetic Colloidssupporting

confidence: 72%

“…58 This was supported by similar findings in a pig model comparing HES 650/0.42 and HES 130/0.43, showing comparably deleterious effects on hemostasis including FVIII/VWF. 59 The in vitro effect of HES 130/0.42 is not reversible by the addition of fibrinogen, 60 which appears compatible with an effect on FVIII/VWF. Subsequently, the effect on FVIII/VWF in HES 130/0.42 was shown to be lower than with other HES.…”

Section: Coagulopathymentioning

confidence: 92%

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Safety of Plasma Volume Expanders

Farrugia¹

2011

The Journal of Clinical Pharmacology

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Hypovolemia from a range of etiologies can lead to severe morbidity and mortality unless blood volume and tissue perfusion are restored. The treatment of hypovolemia has included the improvement and restoration of blood volume loss by the intravenous infusion of plasma expanding therapeutic agents. These have included crystalloid and/or colloid solutions, and a brisk controversy as to which modality is better has engaged therapeutics for the past 30 years. In addition, those favoring either modality have debated which crystalloid, and which colloid, is better. This area was given a dramatic turn a decade ago when a Cochrane meta-analysis concluded that albumin, a historically important plasma expander, resulted in increased mortality when administered to critically ill patients. Although subsequently modified by other studies, the Cochrane meta-analysis has served to generate an ongoing interest in the safety of plasma expanders. This review will assess the safety of these therapies from the viewpoint of the heterogeneous range of clinical indications for which they are used.

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Section: Safety Of the Synthetic Colloidssupporting

confidence: 72%

Section: Coagulopathymentioning

confidence: 92%

Safety of Plasma Volume Expanders

Farrugia¹

2011

The Journal of Clinical Pharmacology

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“…8,20,22,27,32,[45][46][47] Accordingly, HES 650/0.42 had a significantly greater impact on routine coagulation and thrombelastographic parameters than HES 130/0.42. 48 However, effects were similar when observed antihemostatic effects were related to the measured HES plasma concentration. Plasma concentration (in g/L), integrating both the number and the size of circulating molecules, determined the effect on blood coagulation.…”

Section: T H R O M B E L a S To G R A P H Y R E V E A L S H Y P O C Osupporting

confidence: 55%

Effects of hydroxyethyl starches on hemostasis

Kozek‐Langenecker

Scharbert

2007

Transfus Alt Transfus Med

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SUMMARY Hydroxyethyl starch (HES) solutions are frequently used colloidal plasma expanders which are indicated to restore and maintain intravascular volume and to improve tissue perfusion. The development of HES solutions since their introduction into clinical practice has centered on designing starch molecules with an increased oncotic pressure and hemodynamic efficacy while minimizing the risk of adverse reactions such as anticoagulant effects. This article reviews specific anticoagulant side effects of various HES generations, including hetastarch, pentastarch and tetrastarch. Slowly degradable HES solutions have a more pronounced impact on coagulation than rapidly degradable HES. The decrease in factor VIII and von Willebrand factor may be due to complex binding to HES macromolecules and accelerated elimination. Extracellular coating of platelets by HES molecules results in an inhibition of platelet aggregation and adhesion. Thrombin–fibrin interaction, fibrin polymerization, activation of factor XIII, as well as clot resistance to fibrinolytic degradation is reduced in the presence of HES. Balanced salt solutions cause fewer coagulation abnormalities than HES dissolved in saline. Possible approaches to reverse HES‐induced coagulopathy may include the administration of desmopressin, fibrinogen and factor XIII concentrates. Hetastarch attenuates hypercoagulability in patients at risk for thrombotic episodes and increases perioperative bleeding, while blood loss and transfusion requirements were not different in patients exposed to tetrastarch compared with gelatin or albumin. Accordingly, tetrastarch appears to be a suitable volume expander in the routine perioperative setting because of adequate volume efficacy and minimal risk for hemostatic derangements. Contraindications and maximum daily doses need to be acknowledged.

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“…11 In another study, using a hemodilution protocol in pigs, HES plasma concentrations were 1% after 50 mL/kg HES. 12 HES concentrations of 2% and 4% were also used for this study to evaluate the possible effect of higher dosages of HES.…”

Section: Experimental Designmentioning

confidence: 99%