II. Tetrastarch solutions: are they definitely dead?

Moral, V.; Aldecoa, César; Asuero, M.S.

doi:10.1093/bja/aet300

Cited by 58 publications

(1 citation statement)

References 32 publications

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“…PRAC recommends suspending marketing authorisations for infusion solutions containing hydroxyethyl starch: European Medicines Agency & [cited 2013 Jun 14]). However, the clinical perioperative implications of these findings are still uncertain for stable patients undergoing elective surgery (Moral et al 2013 ) . Human albumin (HA) is an alternative fluid that has recently been replacing HES in neurosurgery at Lund University Hospital.…”

Section: Introductionmentioning

confidence: 99%

Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

Statkevicius

Asgeirsson

et al. 2015

Perioper Med

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BackgroundThe European Medicines Agency does not recommend the use of hydroxyethyl starch-based volume replacement solutions in critically ill patients due to an increased risk of renal failure. However, this recommendation is questionable for its perioperative use. Several recent randomised controlled studies do not indicate a risk for renal failure—not even after high-risk surgery. Human albumin is used in our neurointensive care unit as a part of the “Lund concept” of brain injury resuscitation, and albumin has been introduced in elective neurosurgery instead of starch. The aim of our prospective unblinded observational cohort study was to compare the degree of dilutive coagulopathy after albumin and starch intra-operative fluid therapy.MethodsThirty-nine patients undergoing elective brain tumour surgery with craniotomy received either 130/0.42 hydroxyethyl starch or 5 % albumin infusions. The first 18 patients received starch, whereas the rest received albumin. Rotational thromboelastometry with ROTEM and platelet aggregometry with Multiplate were performed before surgery, after the first and second consecutive colloid infusions (250/500 ml albumin or 500/1000 ml starch) and at the end of surgery.ResultsBoth intra- and inter-group comparisons showed more deranged ROTEM parameters after the higher doses of starch. Multiplate detected changes only in the albumin group after 500-ml infusion. Blood los did not differ between groups, nor did haemoglobin preoperatively or at end of surgery. Lower volumes of albumin were required to maintain stable intra-operative haemodynamic parameters; 250/500 ml albumin corresponded to 500/1000 ml starch.ConclusionsHydroxyethyl starch affected coagulation at lower volumes, with a more prominent effect on clot structure at the end of surgery, corroborating previous research. Only albumin decreased platelet aggregation, and 5 % albumin had a more potential volume effect than 130/0.42 hydroxyethyl starch.

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Section: Introductionmentioning

confidence: 99%

Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

Statkevicius

Asgeirsson

et al. 2015

Perioper Med

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Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

Gómez

Vives

Basora³

et al. 2015

Medicina Intensiva

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Cómo citar este artículo: Muñoz Gómez M, et al. Resumen Estos últimos años han aparecido alertas de seguridad, no siempre bien sustentadas, que cuestionan el uso de algunas alternativas farmacológicas a la transfusión de sangre alogénica y/o lo restringen en indicaciones establecidas. Asistimos también a la preconización de otras alternativas, incluyendo productos hemáticos y fármacos antifibrinolíticos, sin que haya una base científica sólida que lo justifique. Por iniciativa del Grupo de Estudios Multidisciplinares sobre Autotransfusión y del Anemia Working Group España se reunió a un panel multidisciplinar de 23 expertos del área de cuidados de la salud en un foro de debate para: 1) analizar las diferentes alertas de seguridad en torno a ciertas alternativas a la transfusión; 2) estudiar los antecedentes que las han propiciado, la evidencia que las sustentan y las consecuencias que conllevan para la práctica clínica, y 3) emitir una valoración argumentada de la seguridad de cada alternativa a la transfusión cuestionada, según el uso clínico de la misma.Los integrantes del foro mantuvieron contactos por vía telemática y una reunión presencial en la que presentaron y discutieron las conclusiones sobre cada uno de los elementos examinados. Se elaboró un primer documento que fue sometido a 4 rondas de revisión y actualización hasta alcanzar un consenso, unánime en la mayoría de los casos. Presentamos la versión final del documento, aprobada por todos los miembros del panel, esperando sea de utilidad para nuestros colegas. © 2015 Elsevier España, S.L.U. y SEMICYUC. Todos los derechos reservados. Abstract In recent years, several safety alerts have questioned or restricted the use of some pharmacological alternatives to allogeneic blood transfusion in established indications. In contrast, there seems to be a promotion of other alternatives, based on blood products and/or antifibrinolytic drugs, which lack a solid scientific basis. KEYWORDSThe Multidisciplinary Autotransfusion Study Group and the Anemia Working Group España convened a multidisciplinary panel of 23 experts belonging to different healthcare areas in a forum for debate to: 1) analyze the different safety alerts referred to certain transfusion alternatives; 2) study the background leading to such alternatives, the evidence supporting them, and their consequences for everyday clinical practice, and 3) issue a weighted statement on the safety of each questioned transfusion alternative, according to its clinical use.The members of the forum maintained telematics contact for the exchange of information and the distribution of tasks, and a joint meeting was held where the conclusions on each of the items examined were presented and discussed. A first version of the document was drafted, and subjected to 4 rounds of review and updating until consensus was reached (unanimously in most cases). We present the final version of the document, approved by all panel members, and hope it will be useful for our colleagues.

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Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient

Gómez

Vives

Macaya³

et al. 2015

Medicina Intensiva (English Edition)

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II. Tetrastarch solutions: are they definitely dead?

Cited by 58 publications

References 32 publications

Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

Effects of different colloid infusions on ROTEM and Multiplate during elective brain tumour neurosurgery

Foro de debate: seguridad de las alternativas a la transfusión alogénica en el paciente quirúrgico y/o crítico

Forum for debate: Safety of allogeneic blood transfusion alternatives in the surgical/critically ill patient

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