The Influence of Intravascular Volume Therapy with a New Hydroxyethyl Starch Preparation (6% HES 130/0.4) on Coagulation in Patients Undergoing Major Abdominal Surgery

Abstract

We compared the effects of infusion of a new hydroxyethyl starch preparation (6% hydroxyethyl starch; mean molecular weight 130,000 daltons; degree of substitution 0.4) on coagulation with a gelatin-based intravascular volume replacement regimen in patients undergoing major abdominal surgery. After moderate doses of hydroxyethyl starch (2430 +/- 310 mL until the morning of the first postoperative day), coagulation monitoring, including modified thrombelastography, did not show impaired hemostasis.

The Effect of Crystalloid vs. Crystalloid plus Colloid Infusion on the Coagulation System in Patients Undergoing Cancer Breast Surgery

“…High MW hestril also resulted in the overall most pronounced impaired platelets aggregation, whereas medium MW hestril did not show the same negative effect on platelets and coagulation function [24]. Other studies in humans confirmed that low MW Hestril preparations can be used without resulting in major bleeding problems [25].…”

The Colloid Crystalloid Debate: Are We Asking the Right Question?

“…120 In patients undergoing major abdominal surgery, Haisch et al compared moderate doses of HES 130/0.4 to a gelatin-based volume-replacement regimen and found similar coagulation profiles. 121 The same group also compared the effect of HES 130/0.4 and gelatin on coagulation in cardiac surgical patients and found similar typical changes in TEG data seen as a result of cardiopulmonary bypass, without identifying any fluid-specific effects. 122 In clinical studies, 6% HES 130/0.4 at a dose of up to 50 mL/kg did not increase blood loss and transfusion requirements in coronary artery bypass surgery compared with 6% HES 200/0.5 at a median dose of 33 mL/kg.…”

Infusion solutions of gelatin derivates

“…D. Fries ir kitų klinicistų atliktuose randomiDalia Adukauskienė, Sandra Mažeikienė, Audronė Veikutienė, Kęstutis Rimaitis zuotuose tyrimuose, tiriant želatinos tirpalų poveikį hemostazei (ilgesnis kraujavimo laikas, antihemofilinio faktoriaus ir von Willebrand faktoriaus sumažėjimas, ilgesnis dalinio aktyvuoto tromboplastino ir protrombino laikas), lyginant su kitais koloidais, nustatyta, jos želatinos derivatai turi mažą neigiamą poveikį krešumo sistemai, o hidroksietilkrakmolo preparatai, priklausomai nuo jų molekulinės masės ir rū-šies, sukelia įvairaus laipsnio (nedidelius ar net grės-mingus gyvybei) kraujavimus (26,27). Todėl D. Fries teigimu, pirmojo pasirinkimo koloidas, skiriant didelius tūrius infuzinių tirpalų, yra modifikuota skysta želatina (28).…”

“…Taigi, želatinos tirpalai neturi įtakos krešumo sistemai net po masyvių infuzijų, kai hemodiliucija siekia 50 proc., todėl jie tinkami vartoti kraujavimo ir net trombocitopenijos atveju (27). Nustatyta, jog chirurginių operacijų atvejais, esant ūminei hemodiliucijai, kai vienas litras kraujo pakeistas vienu litru koloido, ligoniai, gydyti želatinos derivatais, kraujavo mažiau nei gydyti kitais koloidais (26).…”