British Journal of Anaesthesia, 2002, Vol. 89, No. 5 722-728
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend®) on measures of coagulation
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany *Corresponding author
Background. Hydroxyethyl starch (HES) may affect blood coagulation. We studied the effects of a modified, balanced, high-molecular weight [mean molecular weight (MW) 550 kDa], high-substituted [degree of substitution (DS) 0.7] HES preparation (Hextend®) on coagulation in patients undergoing major abdominal surgery.
Methods. Patients were allocated randomly to receive Hextend® (n=21), lactated Ringer’s solution (RL, n=21) or 6% HES with a low MW (130 kDa) and a low DS (0.4) (n=21). The infusion was started after induction of anaesthesia and continued until the second postoperative day to maintain central venous pressure between 8 and 12 mm Hg. Activated thrombelastography (TEG) was used to assess coagulation. Different activators were used (extrinsic and intrinsic activation of TEG) and aprotinin was added to assess hyperfibrinolytic activity (ApTEG). We measured onset of coagulation [coagulation time (CT=reaction time, r)], the kinetics of clot formation [clot formation time (CFT=coagulation time, k)] and maximum clot firmness (MCF=maximal amplitude, MA). Measurements were performed after induction of anaesthesia, at the end of surgery, 5 h after surgery and on the mornings of the first and second days after surgery.
Results. Significantly more HES 130/0.4 [2590 (SD 260) ml] than Hextend® [1970 (310) ml] was given. Blood loss was greatest in the Hextend® group and did not differ between RL- and HES 130/0.4-treated patients. Baseline TEG data were similar and within the normal range. CT and CFT were greater in the Hextend® group immediately after surgery, 5 h after surgery and on the first day than in the two other groups. ApTEG MCF also changed significantly in the Hextend® patients, indicating more pronounced fibrinolysis. Volume replacement using RL caused moderate hypercoagulability, shown by a decrease in CT.
Conclusion. A modified, balanced high-molecular weight HES with a high degree of substitution (Hextend®) adversely affected measures of coagulation in patients undergoing major abdominal surgery, whereas a preparation with a low MW and low DS affected these measures of haemostasis less. Large amounts of RL decreased the coagulation time.
Br J Anaesth 2002; 89: 722–8
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. A. Schramko, R. T. Suojaranta-Ylinen, A. H. Kuitunen, S. I. Kukkonen, and T. T. Niemi Rapidly Degradable Hydroxyethyl Starch Solutions Impair Blood Coagulation After Cardiac Surgery: A Prospective Randomized Trial Anesth. Analg., January 1, 2009; 108(1): 30 - 36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. Kozek-Langenecker, C. Jungheinrich, W. Sauermann, and P. Van der Linden The Effects of Hydroxyethyl Starch 130/0.4 (6%) on Blood Loss and Use of Blood Products in Major Surgery: A Pooled Analysis of Randomized Clinical Trials Anesth. Analg., August 1, 2008; 107(2): 382 - 390. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Mittermayr, W. Streif, T. Haas, D. Fries, C. Velik-Salchner, A. Klingler, and P. Innerhofer Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo Br. J. Anaesth., March 1, 2008; 100(3): 307 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Holte, B. B. Kristensen, L. Valentiner, N. B. Foss, H. Husted, and H. Kehlet Liberal Versus Restrictive Fluid Management in Knee Arthroplasty: A Randomized, Double-Blind Study Anesth. Analg., August 1, 2007; 105(2): 465 - 474. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. J. Gu and P. W. Boonstra Selection of priming solutions for cardiopulmonary bypass in adults MMCTS, January 9, 2006; 2006(0109): 1198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Madjdpour, N. Dettori, P. Frascarolo, M. Burki, M. Boll, A. Fisch, T. Bombeli, and D. R. Spahn Molecular weight of hydroxyethyl starch: is there an effect on blood coagulation and pharmacokinetics? Br. J. Anaesth., May 1, 2005; 94(5): 569 - 576. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Bridges and S. Dukes Cardiovascular Aspects of Septic Shock: Pathophysiology, Monitoring, and Treatment Crit. Care Nurse, April 1, 2005; 25(2): 14 - 40. [Full Text] [PDF]
|
|
|
|
|
|
E. Deusch, U. Thaler, and S. A. Kozek-Langenecker The Effects of High Molecular Weight Hydroxyethyl Starch Solutions on Platelets Anesth. Analg., September 1, 2004; 99(3): 665 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Roche, M. G. Mythen, and M. F. M. James Effects of a new modified balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation Br. J. Anaesth., January 1, 2004; 92(1): 154 - 155. [Full Text] [PDF]
|
|
|
|
|
|
J. Boldt New Light on Intravascular Volume Replacement Regimens: What Did We Learn from the Past Three Years? Anesth. Analg., December 1, 2003; 97(6): 1595 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M Roche and M. F. James Watering down the clots, or are we? Trauma, October 1, 2003; 5(4): 235 - 244. [Abstract] [PDF]
|
|
|
|
|
|
B. E. Ickx, F. Bepperling, C. Melot, C. Schulman, and P. J. Van der Linden Plasma substitution effects of a new hydroxyethyl starch HES 130/0.4 compared with HES 200/0.5 during and after extended acute normovolaemic haemodilution Br. J. Anaesth., August 1, 2003; 91(2): 196 - 202. [Abstract] [Full Text] [PDF]
|
|