The Effect of Hydroxyethyl Starch 200 kD on Platelet Function

Abstract

We evaluated the effects of hydroxyethyl starch with a molecular weight of 200 kD (HES 200 kD) on platelets to gain insight into the potential mechanisms involved in the anticoagulant effects of HES 200 kD. Blood was obtained before and after an IV infusion (10 mL/kg) of either saline (n = 15) or HES 200 kD (n = 15) in otherwise healthy patients scheduled for minor elective surgery. Flow cytometry was used to assess the expression of glycoprotein (GP) IIb-IIIa, GP Ib, and P-selectin on agonist-activated platelets. Overall platelet function was evaluated by assessing thromboelastographic maximum amplitude (MA) in celite-activated blood and platelet function analyzer-closure times by using collagen/adenosine diphosphate cartridges. Saline infusion had no effects on platelet variables, whereas HES 200 kD reduced GP IIb-IIIa expression and MA and prolonged platelet function analyzer-closure times, without affecting the expression of P-selectin and GP Ib. In vitro experiments extended these observations by a concentration-related inhibiting effect of HES 200 kD on GP IIb-IIIa expression. This study demonstrates that cellular abnormalities with decreased availability of platelet GP IIb-IIIa are involved in the anticoagulant effects of HES 200 kD.

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

“…16,17 In addition they can also alter platelet function by inducing cellular abnormalities like a reduction in platelet membrane glycoprotein IIb-IIIa expression. 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.…”

“…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.…”

How to Maintain and Restore Fluid Balance: Colloids

“…However, according to in vitro studies, GP IIb/IIIa expression increases with high MMW, high MSR HES in balanced solutions. This unex-pected result was obtained with a solvent containing calcium chloride dehydrate (2.5 mmol/L) [55,56]. By contrast, HES in balanced plasma-adapted solutions were shown to have fewer effects on platelets.…”

“…By contrast, the newest-generation HES seem to have no negative effects on platelets. Stögermüller et al [55] reported that the expression of platelet GP IIb/IIIa was reduced after the infusion of non-balanced HES 200. However, according to in vitro studies, GP IIb/IIIa expression increases with high MMW, high MSR HES in balanced solutions.…”

Fluid Management and Electrolyte Balance

“…However, according to in vitro studies, GP IIb/IIIa expression increases with high MMW, high MSR HES in a balanced solution. This unexpected result was obtained with a solvent containing calcium chloride dehydrate (2.5 mmol/L) Stögermüller et al 2000). HES in balanced plasma-adapted solutions was shown to have fewer effects on platelets.…”