Effects of different plasma substitutes on blood coagulation: A comparative review

Abstract

Dextran, gelatin, and hydroxyethyl starch (HES) all can induce a specific decrease of von Willebrand factor and factor VIII:c. Blood coagulation is most impaired by dextran and high molecular weight HES, both associated with increased postoperative blood loss. The effects of HES on blood coagulation have been shown to depend on its molecular weight and rate of elimination. Detrimental effects have been shown for high molecular weight HES. Medium molecular weight (MMW)-HES with a high degree of substitution (HES 200/0.62) and MMW-HES with high C2/C6 hydroxyethylation ratio (HES 200/0.5/13) are slowly degradable and have been shown to impair blood coagulation after repeated administration. Rapidly degradable HES 200/0.5/6 and gelatin-based plasma expanders appear not to impair hemostasis. However, based on the reviewed literature, all artificial colloids could potentially induce increased bleeding tendency after infusion of very large volumes and especially when given to patients with even mild forms of von Willebrand disease. In those circumstances, crystalloid solutions or alternatives such as plasma or albumin, although associated with other serious complications, could be considered.

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…Clearance of HES is slowest with high C2:C6 ratios (Westphal et al 2009). HES solutions are therefore classified by their initial MW, degree of substitution, and C2:C6 ratio (de Jonge et al 2001). Usually, HES molecules are mixed with normal saline, but recently HES solutions have also been available in their balanced form (electrolyte concentrations corresponding to those of plasma).…”

A mechanobiological investigation of platelets

“…Thrombospondin platelet aggregation (20) cofactor in coagulation (22), not enzymatically active encourages angiogenesis (14) heparin antagonist (16), angiogenesis inhibitor (23) clotting factor, stimulates neutrophils (chemotaxis, degranulation, adhesion) (24) maintains blood volume (25); impairs platelet aggregation (26) platelet adhesion (16) angiogenesis inhibitor (14); platelet adhesion (16) von Willebrand factor (vWF) (platelets, endothelial platelet-platelet adhesion (16) binds to thrombin cells) and ADP (27) Evidently, the platelet is one essential blood component regulating the haemostatic process because of its adhesive, aggregative and clotting abilities that govern the coagulation cascade. For the same reasons, the platelet is also significant in pathological thrombosis.…”

“…During aggregation, platelet-platelet interaction is reinforced by the contributions of vWF, a large plasma protein that also bridges the gap between the damaged tissue and platelets by means of its shear-induced connection to the platelet membrane glycoprotein receptors (GP Iba) (26,29,32). Collagen and vWF engage the GP VI and GP Ib-IX-V complexes to induce events such as platelet shape change, aggregation and secretion (14), with notable activation of the GP Ilb-IIIa receptor to increase its adhesive properties via shear stress-induced vWF binding to the GP Ib-IX-V complex (26,33).…”

“…Collagen and vWF engage the GP VI and GP Ib-IX-V complexes to induce events such as platelet shape change, aggregation and secretion (14), with notable activation of the GP Ilb-IIIa receptor to increase its adhesive properties via shear stress-induced vWF binding to the GP Ib-IX-V complex (26,33). These agonists are also important initiators in the prominent conformational change of the platelet membrane glycoprotein GP Ilb-IIIa receptor, which exposes a fibrin receptor and a site for binding of soluble ligands (namely fibrinogen) and thus becomes a catalytic location for platelet-platelet interaction (34,35).…”

Coagulation and biochemical effects of balanced salt‐based high molecular weight vs saline‐based low molecular weight hydroxyethyl starch solutions during the anhepatic period of liver transplantation

“…In general, an HES solution with low molecular weight (MW) and low degree of substitution (DS) is preferred because HES solution with high MW and high DS is harder to metabolise or eliminate and thus has a prolonged adverse effect on coagulation [2,[6][7][8][9][10][11][12]. Recently, several studies of balanced salt-based HES solution with high MW and high DS (670 ⁄ 0.75; referred to as bhHES hereafter) have reported beneficial effects on coagulation [13][14][15].…”