Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics? ‡ ‡Declaration of interest. This study was funded in part by B. Braun, of which MB and AF are employees and DS is a paid consultant. B. Braun has funded other research in this department in the past, as have other competitor companies.

Madjdpour, Caveh; Dettori, Nadia; Frascarolo, Philippe; Bürki, Marco; Boll, Meinrad; Fisch, Andreas; Bombeli, Thomas; Spahn, Donat R.

doi:10.1093/bja/aei108

Cited by 53 publications

(6 citation statements)

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“…The turnover of HES based on weight/volume measurements identifies a distribution T 1/2 of 1.4 hours and elimination T 1/2 of 12.1 hours [9]. Other studies yield elimination T 1/2 of approximately 4 hours after infusing HES 130/0.40 [14] or 130/0.42 [15]. Although weight/volume measurements of HES is of interest in toxicology, such data cannot be used uncritically to infer plasma volume expansion over time [8].…”

Section: Discussionmentioning

confidence: 99%

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

et al. 2013

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IntroductionThe turnover of Ringer´s solutions is greatly dependent on the physiological situation, such as the presence of dehydration or anaesthesia. The present study evaluates whether the kinetics is affected by previous infusion of colloid fluid.MethodsTen male volunteers with a mean age of 22 years underwent three infusion experiments, on separate days and in random order. The experiments included 10 mL/kg of 6% hydroxyethyl starch 130/0.4 (Voluven™), 20 mL/kg of Ringer's acetate, and a combination of both, where Ringer´s was administered 75 minutes after the starch infusion ended. The kinetics of the volume expansion was analysed by non-linear least- squares regression, based on urinary excretion and serial measurement of blood haemoglobin concentration for up to 420 minutes.ResultsThe mean volume of distribution of the starch was 3.12 L which agreed well with the plasma volume (3.14 L) estimated by anthropometry. The volume expansion following the infusion of starch showed monoexponential elimination kinetics with a half-life of two hours. Two interaction effects were found when Ringer´s acetate was infused after the starch. First, there was a higher tendency for Ringer´s acetate to distribute to a peripheral compartment at the expense of the plasma volume expansion. The translocated amount of Ringer´s was 70% higher when HES had been infused earlier. Second, the elimination half-life of Ringer´s acetate was five times longer when administered after the starch (88 versus 497 minutes, P <0.02).ConclusionsStarch promoted peripheral accumulation of the later infused Ringer´s acetate solution and markedly prolonged the elimination half-life.Trial registrationClinicalTrials.gov: NCT01195025

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Section: Discussionmentioning

confidence: 99%

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

et al. 2013

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“…Hypoperfusion has been addressed as the predictor of mortality in shock [ 6 ] and is determined by the value of base deficit. Base deficit refers to the amount of base in mili-mol required for titrating 1 L of whole blood to reach a PH of 7.4 in terms of fully oxygenated blood at a temperature of 37 °C and a pCO 2 of 40 mm Hg [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Effectiveness of Hydroxyethyl Starch (Voluven) Solution With Normal Saline in Hemorrhagic Shock Treatment in Trauma

et al. 2016

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BackgroundAppropriate fluid therapy affects morbidity and mortality rates. A conclusion is yet to be reached on the role of crystalloids and colloids in immediate fluid therapy. This study was done to determine the suitable solution in immediate resuscitation of patients with hemorrhagic shock caused by tissue trauma.MethodsOne hundred trauma patients with hemorrhagic shock, who underwent fluid therapy in the emergency unit, were assigned randomly to two groups of hydroxyethyl starch (Voluven) and normal saline. Before and after fluid therapy, 1 cc of blood was taken from all patients in order to determine and compare base excess levels.ResultsIn hydroxyethyl starch (Voluven) and normal saline groups, base excess level after solution therapy increased about 9.65 and 5.46 volumes, respectively, in which augmentation in hydroxyethyl starch (Voluven) group is significantly higher than normal saline group (P ≤ 0.001).ConclusionBy using hydroxyethyl starch (Voluven) for fluid therapy in hemorrhagic shock caused by trauma, serum base excess decreases and results in improvement in tissue perfusion and better balance in acid-base status and it seems to be superior over normal saline administration, but the building block of the ideal fluid therapy should still remain with the physician’s final clinical judgment.

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“…Notably, it has an effect in reducing the density of the fibrinogen network by means of blood volume expansion, thereby modifying blood rheology. In addition, recent data show that the molecular weight of the volume expanders mainly determines the duration of intravascular persistence, and it is not the determining factor in comprising coagulation [25].…”

Section: Discussionmentioning

confidence: 99%

Polymorphism rs2066865 in the Fibrinogen Gamma Chain (FGG) Gene Increases Plasma Fibrinogen Concentration and Is Associated with an Increased Microvascular Thrombosis Rate

Drizlionoka

Zariņš²,

Ozoliņa

et al. 2019

Medicina

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Background and Objective: Thrombosis due to inherited hypercoagulability is an issue that has been raised in microvascular flap surgery previously. We analyzed the association of a single nucleotide polymorphism (SNP) in rs2066865 in the fibrinogen gamma chain (FGG) gene, alteration in plasma fibrinogen concentration, and presence of microvascular flap thrombosis. Materials and Methods: A total of 104 adult patients with microvascular flap surgery were subjected to an analysis of the presence of SNP rs2066865 in the FGG gene. Alterations in plasma fibrinogen concentration according to genotype were determined as a primary outcome, and flap thrombosis was defined as a secondary outcome. Results: Flap thrombosis was detected in 11.5% of patients (n = 12). Successful revision of anastomosis was performed in four patients, resulting in a microvascular flap survival rate of 92.3%. We observed an increase in plasma fibrinogen concentration in genotype G/A and A/A carriers (G/G, 3.9 (IQR 4.76-3.04); G/A, 4.28 (IQR 5.38-3.18); A/A, 6.87 (IQR 8.25-5.49) (A/A vs. G/A, p = 0.003 and A/A vs. G/G, p = 0.001). Within group differences in microvascular flap thrombosis incidence rates were observed—G/G 6/79 (7.59%); G/A 5/22 (22.7%); A/A 1/3 (33.3%) (OR 0.30 95%; CI 0.044 to 0.57), p = 0.016; RR 3.2—when G/G versus G/A and A/A were analyzed respectively. Conclusions: A/A and G/A genotype carriers of a single nucleotide polymorphism in rs2066865 in the fibrinogen gamma chain gene had a higher plasma fibrinogen concentration, and this might be associated with an increased microvascular flap thrombosis incidence rate. Determined polymorphism could be considered as a genetic marker associated with microvascular flap thrombosis development. To confirm the results of this study, the data should be replicated in a greater sample size.

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Abstract: In low-substituted HES, molecular weight is not a key factor in compromising blood coagulation. The longer initial intravascular persistence of high molecular weight low-substituted HES might result in a longer lasting volume effect.

Cited by 53 publications

References 19 publications

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

Interactions between the volume effects of hydroxyethyl starch 130/0.4 and Ringer´s acetate

Comparison of the Effectiveness of Hydroxyethyl Starch (Voluven) Solution With Normal Saline in Hemorrhagic Shock Treatment in Trauma

Polymorphism rs2066865 in the Fibrinogen Gamma Chain (FGG) Gene Increases Plasma Fibrinogen Concentration and Is Associated with an Increased Microvascular Thrombosis Rate

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